Healthcare Provider Details

I. General information

NPI: 1528086980
Provider Name (Legal Business Name): RONNIE CYZNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10370 PARK RD STE 102
CHARLOTTE NC
28210-8509
US

IV. Provider business mailing address

300 BILLINGSLEY RD STE 200
CHARLOTTE NC
28211-1084
US

V. Phone/Fax

Practice location:
  • Phone: 704-543-7305
  • Fax: 704-537-6392
Mailing address:
  • Phone: 704-372-7974
  • Fax: 704-372-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number9901155
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: