Provider Demographics
NPI:1285639443
Name:FLECK, RONDA SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONDA
Middle Name:SUE
Last Name:FLECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2207 CALLE CACIQUE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4944
Mailing Address - Country:US
Mailing Address - Phone:505-985-6443
Mailing Address - Fax:505-985-3212
Practice Address - Street 1:2428 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3512
Practice Address - Country:US
Practice Address - Phone:575-887-0272
Practice Address - Fax:575-628-0279
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90-382085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100118060Medicaid
NM920007138OtherMEDICARE RAILROAD
NM5219123OtherAETNA/PRONET
KY000000657912OtherBCBS COOP HEALTH
NM22213NM00OtherBLUESHIELD/NM
NME5401Medicaid
NM20705OtherLOVELACE HEALTHPLAN
NM713744OtherAHCCCS
NME84280Medicare UPIN
KY33978009Medicare PIN