Provider Demographics
NPI:1548490931
Name:JOHN W RONCK MD PLLC
Entity type:Organization
Organization Name:JOHN W RONCK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:RONCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-233-9254
Mailing Address - Street 1:PO BOX 3842
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-3842
Mailing Address - Country:US
Mailing Address - Phone:580-237-2327
Mailing Address - Fax:580-237-2339
Practice Address - Street 1:305 S 5TH ST
Practice Address - Street 2:ATTN WOUND CARE DEPT
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5832
Practice Address - Country:US
Practice Address - Phone:580-548-5010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty