MEDICARE: RONALD W PELTON M.D., PH.D.

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	207W00000X	Ophthalmology Physician	37739	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144209404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD W PELTON M.D., PH.D.

Provider Business Mailing Address
First Line	:	455 E PIKES PEAK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3674
Country	:	US
Telephone Number	:	719-329-0040
Fax Number	:	719-329-0080

Provider Business Practice Location Address
First Line	:	455 E PIKES PEAK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3648
Country	:	US
Telephone Number	:	719-329-0040
Fax Number	:	719-329-0080

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	02/28/2008

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