Provider Demographics
NPI:1033105275
Name:ALM, RONALD W (DPM)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:ALM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 E MARISOL ST
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-5161
Mailing Address - Country:US
Mailing Address - Phone:208-305-6414
Mailing Address - Fax:
Practice Address - Street 1:1955 E MARISOL ST
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-5161
Practice Address - Country:US
Practice Address - Phone:208-305-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2025-02-17
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
IDP127213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0013290Medicaid
WA0064483OtherL&I
WA1048552OtherWASHINGTON MEDICAID
ID0667930001Medicare NSC
WA0064483OtherL&I
ID1350637Medicare PIN
ID1350636Medicare PIN