Healthcare Provider Details

I. General information

NPI: 1649388422
Provider Name (Legal Business Name): RONALD ROVNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NO. 5 CALLE MEDICO SUITE A
SANTA FE NM
87505-4762
US

IV. Provider business mailing address

7300 RANCH ROAD 2222, BLDG 1, STE 200
AUSTIN TX
78730-3255
US

V. Phone/Fax

Practice location:
  • Phone: 505-557-6300
  • Fax:
Mailing address:
  • Phone: 512-759-8932
  • Fax: 512-233-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number012443
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD2017-1059
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: