Provider Demographics
NPI:1760499818
Name:CARN, RONALD MERVIN (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:MERVIN
Last Name:CARN
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 1:1755 EAST STREET
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-245-0325
Mailing Address - Fax:530-245-0109
Practice Address - Street 1:1755 EAST STREET
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-245-0325
Practice Address - Fax:530-245-0109
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG553290174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G553290Medicaid
CAD35553Medicare UPIN
CAG553290Medicare ID - Type Unspecified
D35553Medicare UPIN