Provider Demographics
NPI:1710065453
Name:KURTZ, RONALD (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:KURTZ
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 1:118 MED SURGE 1
Mailing Address - Street 2:UNIVERSITY OF CALIFORNIA, IRVINE
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697
Mailing Address - Country:US
Mailing Address - Phone:949-824-6256
Mailing Address - Fax:949-824-4015
Practice Address - Street 1:118 MED SURGE 1
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA, IRVINE
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697
Practice Address - Country:US
Practice Address - Phone:949-824-6256
Practice Address - Fax:949-824-4015
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85877207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
W2976OtherGROUP NUMBER
W2976OtherGROUP NUMBER