Provider Demographics
NPI:1629027156
Name:KUNKEL, RALPH M (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:M
Last Name:KUNKEL
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 1:12208 N VIA TESORO AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-8386
Mailing Address - Country:US
Mailing Address - Phone:559-472-3789
Mailing Address - Fax:
Practice Address - Street 1:2614 CLOVER ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1132
Practice Address - Country:US
Practice Address - Phone:509-710-1877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-4821207RC0000X, 207RI0011X
WAM00020829207RC0000X, 207RI0011X
WA20829207RC0000X, 207RI0011X
ORMD202898207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0011551Medicaid
ORMD202898Other207RC0000X
WA8490401Medicaid
ID00037741Medicaid
ID003774100Medicaid
OR105326Medicare PIN
WA000352403Medicare ID - Type Unspecified
WA8490401Medicaid
WAG000352403Medicare PIN
ID11408001Medicare PIN