MEDICARE: DR. RONALD WINFRED OHLSON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	121	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831180330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD WINFRED OHLSON PHD

Provider Business Mailing Address
First Line	:	5153 W 80TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-4114
Country	:	US
Telephone Number	:	907-563-3162
Fax Number	:	907-248-9962

Provider Business Practice Location Address
First Line	:	5153 W 80TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-4114
Country	:	US
Telephone Number	:	907-563-3162
Fax Number	:	907-248-9962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	09/10/2009

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