Provider Demographics
NPI:1801060538
Name:GRASON, RONALD JAMES (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
Last Name:GRASON
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 1:357 W DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522
Mailing Address - Country:US
Mailing Address - Phone:217-428-8600
Mailing Address - Fax:217-428-8600
Practice Address - Street 1:357 W DECATUR ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522
Practice Address - Country:US
Practice Address - Phone:217-428-8600
Practice Address - Fax:217-428-8600
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12310Medicare UPIN
IL461560Medicare PIN