Provider Demographics
NPI:1881932168
Name:SOMMER, RONALD MERTON (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MERTON
Last Name:SOMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 POPPY TRL
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90274-5137
Mailing Address - Country:US
Mailing Address - Phone:310-541-9005
Mailing Address - Fax:310-541-7979
Practice Address - Street 1:1436 W. 23RD ST.
Practice Address - Street 2:WESTSIDE FREE CLINIC
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810
Practice Address - Country:US
Practice Address - Phone:562-432-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAL.AFE18445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A21326Medicare UPIN