Provider Demographics
NPI:1912009283
Name:BIESELIN, RONALD GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GEORGE
Last Name:BIESELIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:480 REDWOOD ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-2958
Mailing Address - Country:US
Mailing Address - Phone:707-642-2111
Mailing Address - Fax:707-642-2158
Practice Address - Street 1:480 REDWOOD ST
Practice Address - Street 2:SUITE 14
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-2958
Practice Address - Country:US
Practice Address - Phone:707-642-2111
Practice Address - Fax:707-642-2158
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG41512208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48591Medicare UPIN
CA00G415120Medicare ID - Type Unspecified