MEDICARE: MR. RONALD ANTHONY DEUTSCH PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	318	CO

General Provider Information

NPI Number	:	1134108509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD ANTHONY DEUTSCH PA

Provider Business Mailing Address
First Line	:	14505 LATROBE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-2614
Country	:	US
Telephone Number	:	719-526-7489
Fax Number	:	719-526-7181

Provider Business Practice Location Address
First Line	:	1650 COCHRANE CIR
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4603
Country	:	US
Telephone Number	:	719-526-7489
Fax Number	:	719-526-7181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	07/08/2007

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