Provider Demographics
NPI:1225013691
Name:RONDON, LUIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:RONDON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2300 WILSON BLVD SUITE 500
Mailing Address - Street 2:US COAST GUARD RECRUITING COMMAND
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:20598-7500
Mailing Address - Country:US
Mailing Address - Phone:703-235-1745
Mailing Address - Fax:703-235-1883
Practice Address - Street 1:2100 2ND ST. SW
Practice Address - Street 2:HSWL-FO NATIONAL CAPITAL AREA
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593
Practice Address - Country:US
Practice Address - Phone:202-372-4100
Practice Address - Fax:202-372-4910
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2012-08-20
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Provider Licenses
StateLicense IDTaxonomies
PR7717171000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider