Provider Demographics
NPI:1922010941
Name:ROWBERRY, RONALD D (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:D
Last Name:ROWBERRY
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 1:3301 C ST
Mailing Address - Street 2:SUITE 200-E
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3300
Mailing Address - Country:US
Mailing Address - Phone:916-447-6267
Mailing Address - Fax:916-447-0621
Practice Address - Street 1:3301 C ST
Practice Address - Street 2:SUITE 200-E
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3300
Practice Address - Country:US
Practice Address - Phone:916-447-6267
Practice Address - Fax:916-447-0621
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68985174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI625478Medicaid
CA00A689850Medicaid
HI625478Medicaid
CA220032687Medicare UPIN
CAH69849Medicare ID - Type Unspecified