Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | L3053 | TX |
Y | 207RA0401X | Internist - Addiction Medicine | E-11924 | AR |
NPI | 1710964226 |
---|---|
Provider Name | Ronald C Only |
First Address | Augusta, AR 72006-0497 |
Second Address | Jonesboro, AR 72401-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 23/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
260224705 | TAX IDENTIFICATION (01) | TX |
70121701 | DPS (01) | TX |
BO7231537 | DEA (01) | TX |
H78060 | (02) | TX |