Provider Demographics
NPI:1013960228
Name:KILLAM, RONALD WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WAYNE
Last Name:KILLAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 96706
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77213-6706
Mailing Address - Country:US
Mailing Address - Phone:713-330-0766
Mailing Address - Fax:877-862-8370
Practice Address - Street 1:11110 EAST FWY STE 100A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-1914
Practice Address - Country:US
Practice Address - Phone:713-330-0766
Practice Address - Fax:877-862-8370
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111525501Medicaid
TX111525504Medicaid
TX810621291OtherTAX IDENTIFICATION
TX8Z1542OtherBLUECROSS BLUESHIELD
TX111525505Medicaid
TX460986471OtherTAX IDENTIFICATION
TX8K3280OtherBLUE CROSS SHIELD
TX1518219104OtherGROUP NPI
TX00511BOtherBLUECROSS BLUESHIELD
TX10014941Medicaid
TX8Z1542OtherBLUECROSS BLUESHIELD
TX810621291OtherTAX IDENTIFICATION