Provider Demographics
NPI:1770703787
Name:JOLLO, RONALD (DO)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:JOLLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 NE MAKER WAY
Mailing Address - Street 2:STE #2
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4289
Mailing Address - Country:US
Mailing Address - Phone:541-389-6378
Mailing Address - Fax:
Practice Address - Street 1:2366 NW LAKESIDE PL
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3535
Practice Address - Country:US
Practice Address - Phone:541-389-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD016603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD86920Medicare UPIN