Provider Demographics
NPI:1073850541
Name:AEBERSOLD, RONALD ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ROBERT
Last Name:AEBERSOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 COLONY DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2122
Mailing Address - Country:US
Mailing Address - Phone:972-259-8837
Mailing Address - Fax:972-253-0865
Practice Address - Street 1:1405 COLONY DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2122
Practice Address - Country:US
Practice Address - Phone:972-259-8837
Practice Address - Fax:972-253-0865
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6360207R00000X
ARC-40007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB20800Medicare UPIN