Provider Demographics
NPI:1861677460
Name:WORLAND, RONALD G (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:WORLAND
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 1:700 CRATER LAKE AVE
Mailing Address - Street 2:APT 104
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6544
Mailing Address - Country:US
Mailing Address - Phone:541-854-7596
Mailing Address - Fax:541-972-8682
Practice Address - Street 1:2959 SISKIYOU BLVD
Practice Address - Street 2:STE A
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8131
Practice Address - Country:US
Practice Address - Phone:541-854-7596
Practice Address - Fax:541-972-8682
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10533208600000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR019802Medicaid
ORR14018Medicare PIN
OR019802Medicaid