Provider Demographics
NPI:1477567899
Name:PUST, RONALD E (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:PUST
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 1:2003 E CALLE ALTA VIS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-3202
Mailing Address - Country:US
Mailing Address - Phone:520-626-7822
Mailing Address - Fax:520-626-6134
Practice Address - Street 1:2003 E CALLE ALTA VIS
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-3202
Practice Address - Country:US
Practice Address - Phone:520-626-7822
Practice Address - Fax:520-626-6134
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM53359551Medicaid
AZ11403OtherARIZONA MEDICAL LICENSE
24776OtherUSPHS COM.CORPS. NO.
24776OtherUSPHS COM.CORPS. NO.