Provider Demographics
NPI:1811172802
Name:WHITELAW, RONALD DAVID
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DAVID
Last Name:WHITELAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MARKET ST STE 60
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-2395
Mailing Address - Country:US
Mailing Address - Phone:541-451-1733
Mailing Address - Fax:541-451-4902
Practice Address - Street 1:90 MARKET ST STE 60
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2395
Practice Address - Country:US
Practice Address - Phone:541-451-1733
Practice Address - Fax:541-451-4902
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-173652237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006093Medicaid