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General NPI Number Information
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NPI Number | 1679641153
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Entity Type | Organization
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Legal Business Name | RONALD G CONNOLLY MD
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 1776 YGNACIO VALLEY ROAD SUITE 106
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City | WALNUT CREEK
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State | CA
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Zip | 94598
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Country | US
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Telephone | 925-974-7000
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Fax | 925-974-7003
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Provider Business Mailing Address
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Address Line | 1776 YGNACIO VALLEY ROAD SUITE 106
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City | WALNUT CREEK
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State | CA
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Zip | 94598
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Country | US
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Telephone | 925-974-7000
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Fax | 925-974-7003
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Authorized Official
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Title or Position | OWNER
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Name | RONALD G CONNOLLY
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Credential | MD
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Telephone | 925-974-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | G13521
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License Number State | CA
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