Healthcare Provider Details

I. General information

NPI: 1285658351
Provider Name (Legal Business Name): RONALD JAMES PERON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 WESLEY ST
GREENVILLE TX
75401-5639
US

IV. Provider business mailing address

PO BOX 1908
GREENVILLE TX
75403-1908
US

V. Phone/Fax

Practice location:
  • Phone: 903-455-5958
  • Fax: 903-454-4621
Mailing address:
  • Phone: 903-454-3025
  • Fax: 903-450-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG8941
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: