Provider Demographics
NPI:1770547465
Name:WALOFF, RONALD I (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:I
Last Name:WALOFF
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 1:243 GREEN VALLEY RD STE E
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3133
Mailing Address - Country:US
Mailing Address - Phone:831-722-8807
Mailing Address - Fax:831-998-7155
Practice Address - Street 1:243 GREEN VALLEY RD STE E
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3133
Practice Address - Country:US
Practice Address - Phone:831-722-8807
Practice Address - Fax:831-722-8809
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87858207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0875168Medicaid
PA0875168Medicaid
106229Medicare PIN