Basic Information
| Provider Information | |||||||||
| NPI: | 1104081314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASE | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 2196 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985072196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607892441 | ||||||||
| FaxNumber: | 3604914947 | ||||||||
| Practice Location | |||||||||
| Address1: | 4705 8TH AVENUE N.E. | ||||||||
| Address2: | |||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985166301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607892441 | ||||||||
| FaxNumber: | 3604914947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2008 | ||||||||
| LastUpdateDate: | 07/28/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | MD00011407 | WA | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207Q00000X | MD00011407 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | AC3131620 | 01 | DEA | OTHER |