Provider Demographics
NPI:1184622532
Name:DAVIS, RONALD T (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:T
Last Name:DAVIS
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:PO BOX 33865
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3865
Mailing Address - Country:US
Mailing Address - Phone:619-220-4100
Mailing Address - Fax:619-270-3423
Practice Address - Street 1:2466 1ST AVE
Practice Address - Street 2:STE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1408
Practice Address - Country:US
Practice Address - Phone:619-230-0400
Practice Address - Fax:619-325-3688
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21783174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG21783OtherCALIFORNIA LICENSE
CA00G217830Medicaid
CAAD0021357OtherDEA CERTIFICATE
CAA41387Medicare UPIN
CAWG21783RMedicare PIN
CAWG21783HMedicare PIN
CAWG21783QMedicare PIN
CAWG21783OMedicare PIN
CAWG21783MMedicare PIN
CAWG21783LMedicare PIN
CAG21783OtherCALIFORNIA LICENSE
CAWG21783Medicare ID - Type Unspecified