Provider Demographics
NPI:1356316111
Name:RANSOM, NICHOLAS A (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:RANSOM
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 1:1701 W ST MARY'S RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2683
Mailing Address - Country:US
Mailing Address - Phone:520-624-0888
Mailing Address - Fax:520-624-0091
Practice Address - Street 1:1701 W SAINT MARYS RD STE 114
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2621
Practice Address - Country:US
Practice Address - Phone:520-729-1300
Practice Address - Fax:520-495-2683
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18436207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ28666801Medicaid
AZZMD18436Medicare PIN
MD18436Medicare ID - Type Unspecified
A49843Medicare UPIN