Provider Demographics
NPI:1871642801
Name:ROUDON, RONALD WARREN (ATC RETIRED ,LAT)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WARREN
Last Name:ROUDON
Suffix:
Gender:M
Credentials:ATC RETIRED ,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 PEGGY LN
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-5832
Mailing Address - Country:US
Mailing Address - Phone:817-478-3939
Mailing Address - Fax:
Practice Address - Street 1:1403 PEGGY LN
Practice Address - Street 2:
Practice Address - City:KENNEDALE
Practice Address - State:TX
Practice Address - Zip Code:76060-5832
Practice Address - Country:US
Practice Address - Phone:817-478-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT 0208247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other