Healthcare Provider Details

I. General information

NPI: 1740266972
Provider Name (Legal Business Name): RONALD DAVID SIMON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 ERRECART BLVD SUITE 208
ELKO NV
89801-8346
US

IV. Provider business mailing address

1995 ERRECART BLVD SUITE 208
ELKO NV
89801-8346
US

V. Phone/Fax

Practice location:
  • Phone: 775-777-8008
  • Fax: 775-996-4318
Mailing address:
  • Phone: 775-777-8008
  • Fax: 775-996-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number054340
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1621
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: