Provider Demographics
NPI:1437142940
Name:AMMON, RONDA G (DPM)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:G
Last Name:AMMON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 E PIKES PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5619
Mailing Address - Country:US
Mailing Address - Phone:719-475-8080
Mailing Address - Fax:719-475-0913
Practice Address - Street 1:1612 E PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5619
Practice Address - Country:US
Practice Address - Phone:719-475-8080
Practice Address - Fax:719-475-0913
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO331213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04011300Medicaid
COCA0523Medicare PIN
CO04011300Medicaid
CO0362470003Medicare NSC