Provider Demographics
NPI:1174640585
Name:TINKHAM, RONALD EUEGENE
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:EUEGENE
Last Name:TINKHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1233
Mailing Address - Country:US
Mailing Address - Phone:937-564-0491
Mailing Address - Fax:
Practice Address - Street 1:314 MAYFAIR BLVD APT B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2226
Practice Address - Country:US
Practice Address - Phone:937-564-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2375371Medicaid