Provider Demographics
NPI:1891707998
Name:INCIONG, RAMON B (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:B
Last Name:INCIONG
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 1:600 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1512
Mailing Address - Country:US
Mailing Address - Phone:815-883-3241
Mailing Address - Fax:815-883-3347
Practice Address - Street 1:402 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:OGLESBY
Practice Address - State:IL
Practice Address - Zip Code:61348-1453
Practice Address - Country:US
Practice Address - Phone:815-883-3241
Practice Address - Fax:815-883-3347
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084592207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084592Medicaid
F30408Medicare UPIN