Healthcare Provider Details

I. General information

NPI: 1134379019
Provider Name (Legal Business Name): RON AYRES RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20002 SE 42ND ST
CAMAS WA
98607-9432
US

IV. Provider business mailing address

20002 SE 42ND ST
CAMAS WA
98607-9432
US

V. Phone/Fax

Practice location:
  • Phone: 360-833-8352
  • Fax: 360-833-9412
Mailing address:
  • Phone: 360-833-8352
  • Fax: 360-833-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License NumberRT-P-001029
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: