Provider Demographics
NPI:1700936838
Name:DAVIS, RONALD BALDWIN (MD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:BALDWIN
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 1:2629 E HARRY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-4702
Mailing Address - Country:US
Mailing Address - Phone:316-618-8644
Mailing Address - Fax:316-618-8730
Practice Address - Street 1:2629 E HARRY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-4702
Practice Address - Country:US
Practice Address - Phone:316-618-8644
Practice Address - Fax:316-618-8730
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS152032083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79360Medicare UPIN