Provider Demographics
NPI:1366655003
Name:PINKARD, RONALD WAYNE (DPM)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:WAYNE
Last Name:PINKARD
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 1:201 E. 12TH ST
Mailing Address - Street 2:#308
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-2243
Mailing Address - Country:US
Mailing Address - Phone:510-597-0283
Mailing Address - Fax:
Practice Address - Street 1:400 40TH ST
Practice Address - Street 2:STE 202
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2509
Practice Address - Country:US
Practice Address - Phone:510-597-0283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE-2493213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E24930OtherMEDI-CAL ID
000E24930Medicare ID - Type Unspecified
CAT11357Medicare UPIN