MEDICARE: RONALD A SHOCKLEY M.D.

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	207RI0200X	Infectious Disease Physician	9492	NV

General Provider Information

NPI Number	:	1275511263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD A SHOCKLEY M.D.

Provider Business Mailing Address
First Line	:	3483 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3314
Country	:	US
Telephone Number	:	702-309-2311
Fax Number	:	702-309-2177

Provider Business Practice Location Address
First Line	:	3483 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3314
Country	:	US
Telephone Number	:	702-309-2311
Fax Number	:	702-309-2177

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	09/16/2022

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