Basic Information
| Provider Information | |||||||||
| NPI: | 1548490931 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN W RONCK MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3842 | ||||||||
| Address2: | |||||||||
| City: | ENID | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737023842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802372327 | ||||||||
| FaxNumber: | 5802372339 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 S 5TH ST | ||||||||
| Address2: | ATTN WOUND CARE DEPT | ||||||||
| City: | ENID | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737015832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5805485010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2009 | ||||||||
| LastUpdateDate: | 07/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | RONCK | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5802339254 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.