Healthcare Provider Details

I. General information

NPI: 1093246167
Provider Name (Legal Business Name): ALAN RONNING C-PED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9023 E DESERT COVE AVE
SCOTTSDALE AZ
85260-6714
US

IV. Provider business mailing address

9023 E DESERT COVE AVE
SCOTTSDALE AZ
85260-6714
US

V. Phone/Fax

Practice location:
  • Phone: 480-614-8820
  • Fax:
Mailing address:
  • Phone: 480-614-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: