MEDICARE: RONALD W CENTRIC D.O.

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	2084P0800X	Psychiatry Physician	574	NV

General Provider Information

NPI Number	:	1396845921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD W CENTRIC D.O.

Provider Business Mailing Address
First Line	:	343 FAIRVIEW DR
Second Line	:	SUITE 104
City	:	CARSON CITY
State	:	NV
Zip	:	89701-5303
Country	:	US
Telephone Number	:	775-887-0703
Fax Number	:

Provider Business Practice Location Address
First Line	:	343 FAIRVIEW DR
Second Line	:	SUITE 104
City	:	CARSON CITY
State	:	NV
Zip	:	89701-5303
Country	:	US
Telephone Number	:	775-887-0703
Fax Number	:

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

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	07/08/2007

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