Healthcare Provider Details

I. General information

NPI: 1760602411
Provider Name (Legal Business Name): SEGUNDO G RONCAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N THIRD ST
DODSON LA
71422-3871
US

IV. Provider business mailing address

105 N THIRD ST
DODSON LA
71422-3871
US

V. Phone/Fax

Practice location:
  • Phone: 318-628-2600
  • Fax: 318-628-2604
Mailing address:
  • Phone: 318-628-2600
  • Fax: 318-628-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number5279
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: