Provider Demographics
NPI:1811995210
Name:WAYNE, RONALD G (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:G
Last Name:WAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:990 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2851
Mailing Address - Country:US
Mailing Address - Phone:360-479-3657
Mailing Address - Fax:360-373-7616
Practice Address - Street 1:990 SYLVAN WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2851
Practice Address - Country:US
Practice Address - Phone:360-479-3657
Practice Address - Fax:360-373-7616
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041295207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8327348Medicaid
WA910847215OtherPREMERA BLUE CROSS
WA91084721534OtherKPS
WA162563OtherLABOR AND INDUSTRIES
WA016487001OtherGROUP HEALTH CORP
WA7215WAOtherREGENCE BLUE SHIELD
WA8934191OtherVICTIMS OF CRIME
WA910847215OtherUNIFORM MEDICAL
WA05089172OtherRAILROAD MEDICARE
WA91084721534OtherKPS
WAA50428Medicare UPIN