Provider Demographics
NPI:1538168604
Name:STINSON, RONALD G (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:STINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50460
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-0460
Mailing Address - Country:US
Mailing Address - Phone:307-577-0136
Mailing Address - Fax:307-687-7243
Practice Address - Street 1:1233 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2926
Practice Address - Country:US
Practice Address - Phone:307-577-2198
Practice Address - Fax:307-687-7243
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4696A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY100103500Medicaid
WY100103500Medicaid
WY306350Medicare ID - Type Unspecified