Provider Demographics
NPI:1003346305
Name:DORIA, RONALD SB (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SB
Last Name:DORIA
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 1:683 WAIANAE AVE BLDG G 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD BARRACKS
Mailing Address - State:HI
Mailing Address - Zip Code:96786
Mailing Address - Country:US
Mailing Address - Phone:801-735-1290
Mailing Address - Fax:
Practice Address - Street 1:683 WAIANAE AVE BLDG G 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96786
Practice Address - Country:US
Practice Address - Phone:801-735-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116030819207Q00000X
VA0101265694207Q00000X
CODR.0065226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029253OtherKAISER COMMERCIAL NUMBER
VA0116030819OtherVIRGINIA