Healthcare Provider Details

I. General information

NPI: 1447221817
Provider Name (Legal Business Name): RONALD M ROAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 STONE AVENUE
TALLADEGA AL
35610-2217
US

IV. Provider business mailing address

1012 IRVING RD
HOMEWOOD AL
35209-3428
US

V. Phone/Fax

Practice location:
  • Phone: 205-979-5882
  • Fax: 205-979-1248
Mailing address:
  • Phone: 205-427-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24176
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number24176
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number24176
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number24176
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24176
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: