Provider Demographics
NPI:1649378696
Name:NORMAN, RONALD KEITH (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:KEITH
Last Name:NORMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2736 COLDSPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6646
Mailing Address - Country:US
Mailing Address - Phone:937-431-4749
Mailing Address - Fax:937-431-5316
Practice Address - Street 1:2736 COLDSPRINGS DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6646
Practice Address - Country:US
Practice Address - Phone:937-431-4749
Practice Address - Fax:937-431-5316
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-3041-N213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2100943Medicaid
OHNO 0841863Medicare ID - Type Unspecified
OH2100943Medicaid