Provider Demographics
NPI:1396845921
Name:CENTRIC, RONALD W (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:CENTRIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 FAIRVIEW DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5303
Mailing Address - Country:US
Mailing Address - Phone:775-887-0703
Mailing Address - Fax:
Practice Address - Street 1:343 FAIRVIEW DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5303
Practice Address - Country:US
Practice Address - Phone:775-887-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVC98183Medicare UPIN
NVDO574AMedicare ID - Type Unspecified