Provider Demographics
NPI:1619078201
Name:DEVORE, RONALD LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:DEVORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7831 LOCUST GROVE CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-7118
Mailing Address - Country:US
Mailing Address - Phone:937-776-3260
Mailing Address - Fax:937-312-9369
Practice Address - Street 1:7831 LOCUST GROVE CT
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-7118
Practice Address - Country:US
Practice Address - Phone:937-776-3260
Practice Address - Fax:937-312-9369
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01091188A207Y00000X
OH35-06-1143-D207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0818931Medicaid
OHDE0690684Medicare PIN
OH0818931Medicaid