Provider Demographics
NPI:1922039247
Name:HAMPTON, RONALD LEE (IDC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LEE
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 SEALION RD
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98315-7102
Mailing Address - Country:US
Mailing Address - Phone:360-315-4166
Mailing Address - Fax:360-315-4101
Practice Address - Street 1:7111 SEALION RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98315-7102
Practice Address - Country:US
Practice Address - Phone:360-315-4166
Practice Address - Fax:360-315-4101
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman