Provider Demographics
NPI:1356442032
Name:HART, RONALD D (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:HART
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 1390
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-1390
Mailing Address - Country:US
Mailing Address - Phone:530-755-1007
Mailing Address - Fax:530-755-1711
Practice Address - Street 1:1085 GRAY AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991
Practice Address - Country:US
Practice Address - Phone:530-755-1007
Practice Address - Fax:530-755-1711
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA080195367OtherRAILROAD MEDICARE
CA5236029Medicaid
CA00G850933Medicare PIN
CAF24371Medicare UPIN
CA5236029Medicaid