MEDICARE: DR. RONALD SCOTT HAXTON 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	208000000X	Pediatrics Physician	A22838	CA

General Provider Information

NPI Number	:	1720037864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD SCOTT HAXTON M.D.

Provider Business Mailing Address
First Line	:	27771 HORSESHOE BND
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1522
Country	:	US
Telephone Number	:	949-443-1791
Fax Number	:	949-443-1793

Provider Business Practice Location Address
First Line	:	27800 MEDICAL CENTER RD
Second Line	:	SUITE 204
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6410
Country	:	US
Telephone Number	:	949-364-3532
Fax Number	:	949-347-7645

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	01/11/2012

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