Provider Demographics
NPI:1841372802
Name:SAND, RONALD WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:WILLIAM
Last Name:SAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1321 BUTTE ST
Mailing Address - Street 2:# 202
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1034
Mailing Address - Country:US
Mailing Address - Phone:530-246-5710
Mailing Address - Fax:877-554-1030
Practice Address - Street 1:1100 BUTTE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0852
Practice Address - Country:US
Practice Address - Phone:530-949-2259
Practice Address - Fax:530-229-3703
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG59979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53539Medicare UPIN
CA00G599791Medicare ID - Type Unspecified