Provider Demographics
NPI:1760468896
Name:HEILPERN, RONALD JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JEFFREY
Last Name:HEILPERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R
Other - Middle Name:JEFFREY
Other - Last Name:HEILPERN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-773-9750
Mailing Address - Fax:760-773-9294
Practice Address - Street 1:72780 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-7103
Practice Address - Country:US
Practice Address - Phone:760-773-9750
Practice Address - Fax:760-773-9294
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41040207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A29281Medicare UPIN
00A410401Medicare ID - Type Unspecified