Provider Demographics
NPI:1720208481
Name:RONALD C. ALLISON M.D. INC.
Entity Type:Organization
Organization Name:RONALD C. ALLISON M.D. INC.
Other - Org Name:STOCKTON UROLOGICAL MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-943-2107
Mailing Address - Street 1:415 E HARDING WAY STE H
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6118
Mailing Address - Country:US
Mailing Address - Phone:209-943-2107
Mailing Address - Fax:209-943-1048
Practice Address - Street 1:415 E HARDING WAY STE H
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6118
Practice Address - Country:US
Practice Address - Phone:209-943-2107
Practice Address - Fax:209-943-1048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15360174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0040550Medicaid
CAGR0040550Medicaid
CAZZZ95415ZMedicare ID - Type Unspecified