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NPI Code Detail

MEDICARE: RON MANSOLO MD PA

MEDICARE: RON MANSOLO MD 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
1208D00000XGeneral Practice Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10039GHOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1679574685
Entity Type Code : Organization
Provider Name (Legal Business Name) : RON MANSOLO MD PA
Provider Business Mailing Address
First Line : 902 CRYSTAL FALLS PKWY
Second Line :
City : LEANDER
State : TX
Zip : 78641-3646
Country : US
Telephone Number : 512-259-2222
Fax Number : 512-259-2290
Provider Business Practice Location Address
First Line : 902 CRYSTAL FALLS PKWY
Second Line :
City : LEANDER
State : TX
Zip : 78641-3646
Country : US
Telephone Number : 512-259-2222
Fax Number : 512-259-2290
Authorized Official
Title or Position : OFFICE MANAGER
Name : JENNIFER G PASSONS
Credential :
Telephone Number : 512-968-7570
Provider Enumeration Date : 08/02/2005
Last Update Date : 03/09/2011

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902 CRYSTAL FALLS PKWY
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78641-3646
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LEANDER, TX
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Directions to “RON MANSOLO MD PA ” Practice Location

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