Basic Information
| Provider Information | |||||||||
| NPI: | 1710062864 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOAN | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | DAVID | ||||||||
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| NameSuffix: | III | ||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1925 BRETON RD SE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495064810 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8088 VINEYARD DRIVE | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2692867090 | ||||||||
| FaxNumber: | 2692867091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601004939 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.