Provider Demographics
NPI:1508003260
Name:KENNETH J. RANSOM, MD, PLC
Entity Type:Organization
Organization Name:KENNETH J. RANSOM, MD, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:RANSOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-414-7077
Mailing Address - Street 1:6812 E MONTERRA WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-8856
Mailing Address - Country:US
Mailing Address - Phone:480-414-7077
Mailing Address - Fax:480-882-4276
Practice Address - Street 1:6812 E MONTERRA WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-8856
Practice Address - Country:US
Practice Address - Phone:480-414-7077
Practice Address - Fax:480-882-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36291208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty