Provider Demographics
NPI:1477931459
Name:SALLOUM, RONY
Entity Type:Individual
Prefix:DR
First Name:RONY
Middle Name:
Last Name:SALLOUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HORSESHOE CIR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-4580
Mailing Address - Country:US
Mailing Address - Phone:412-478-3989
Mailing Address - Fax:
Practice Address - Street 1:4351 E LOHMAN AVE STE 320
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8262
Practice Address - Country:US
Practice Address - Phone:575-522-4940
Practice Address - Fax:575-522-4932
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2022-1039208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery