Provider Demographics
NPI:1013911577
Name:VARCAK, RONALD JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:VARCAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-8000
Mailing Address - Country:US
Mailing Address - Phone:931-456-9434
Mailing Address - Fax:931-456-5061
Practice Address - Street 1:133 HAYES ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-8000
Practice Address - Country:US
Practice Address - Phone:931-456-9434
Practice Address - Fax:931-456-5061
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2425207Q00000X, 2083P0500X, 2083P0500X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C64410Medicare UPIN
TN10308I6551Medicare PIN