Healthcare Provider Details

I. General information

NPI: 1356316111
Provider Name (Legal Business Name): NICHOLAS A RANSOM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W SAINT MARYS RD STE 114
TUCSON AZ
85745-2621
US

IV. Provider business mailing address

1701 W ST MARY'S RD SUITE 145
TUCSON AZ
85745-2683
US

V. Phone/Fax

Practice location:
  • Phone: 520-729-1300
  • Fax: 520-495-2683
Mailing address:
  • Phone: 520-624-0888
  • Fax: 520-624-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number18436
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number18436
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: