Provider Demographics
NPI:1043217169
Name:ELDER, RONALD B (MD, PSC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:B
Last Name:ELDER
Suffix:
Gender:M
Credentials:MD, PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1623 NASHVILLE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-8889
Mailing Address - Country:US
Mailing Address - Phone:270-726-3303
Mailing Address - Fax:270-726-3910
Practice Address - Street 1:1623 NASHVILLE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8889
Practice Address - Country:US
Practice Address - Phone:270-726-3303
Practice Address - Fax:270-726-3910
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY34620208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY611349692OtherNATIONAL TELEPHONE COOPER
KY611349692OtherMISCELLANEOUS COMMERCIAL
PA1010779800001Medicaid
KY611349692OtherHUMANA
KY611349692OtherUNITED HEALTH CARE
KY611349692OtherCHA
KY611349692OtherRESERVE NATIONAL
KY2364418006OtherCIGNA
KY48417OtherPHCS
KY5076198OtherAETNA US HEALTHCARE (MC)
KY611349692OtherCENTER CARE
KY1631299OtherFIRST HEALTH NETWORK
KY64346208Medicaid
KY000000065383OtherANTHEM
KY23J8OtherANTHEM FEP
KY611349692OtherUNITED HEALTH CARE - RAIL