Provider Demographics
NPI:1205889391
Name:CULVER, RONALD EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EUGENE
Last Name:CULVER
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 1:308 VILLA RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1830
Mailing Address - Country:US
Mailing Address - Phone:503-538-7407
Mailing Address - Fax:503-537-0640
Practice Address - Street 1:308 VILLA RD
Practice Address - Street 2:SUITE 116
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1830
Practice Address - Country:US
Practice Address - Phone:503-538-7407
Practice Address - Fax:503-537-0640
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23445208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286813Medicaid
52801Medicare ID - Type Unspecified
ORA41721Medicare UPIN