Provider Demographics
NPI:1396725164
Name:DUVALL, RONALD DEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DEAN
Last Name:DUVALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N COAST HWY
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3115
Mailing Address - Country:US
Mailing Address - Phone:541-272-5006
Mailing Address - Fax:541-272-5067
Practice Address - Street 1:407 N COAST HWY
Practice Address - Street 2:SUITE 100-A
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3115
Practice Address - Country:US
Practice Address - Phone:541-272-5066
Practice Address - Fax:541-272-5067
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR426103G00000X, 103TC0700X, 103TF0200X, 103T00000X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR092481Medicaid
OR092481Medicaid