Individual
DR. RONNIE D SHADE
Active
Individual
DR. RONNIE D SHADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G6395
TX
207XS0106X
Orthopaedic Hand Surgery Physician
G6395
TX
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
G6395
TX
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
G6395
TX
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
G6395
TX
207XX0801X
Orthopaedic Trauma Physician
G6395
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00CW90
MEDICARE ID
—
05
—
032574801
—
TX
01
—
472312ZS6W
MEDICARE ID
—
Enumeration date
07/13/2005
Last updated
11/29/2016
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