Provider Demographics
NPI:1275511263
Name:SHOCKLEY, RONALD A (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:SHOCKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3483 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3314
Mailing Address - Country:US
Mailing Address - Phone:702-309-2311
Mailing Address - Fax:702-309-2177
Practice Address - Street 1:3483 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3314
Practice Address - Country:US
Practice Address - Phone:702-309-2311
Practice Address - Fax:702-309-2177
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9492207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV103778Medicare PIN