Provider Demographics
NPI:1891837696
Name:DEGON, RONALD AURTHUR (RSA, SA-C, CSA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:AURTHUR
Last Name:DEGON
Suffix:
Gender:M
Credentials:RSA, SA-C, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 GLENBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-8769
Mailing Address - Country:US
Mailing Address - Phone:309-831-8326
Mailing Address - Fax:
Practice Address - Street 1:1804 GLENBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-8769
Practice Address - Country:US
Practice Address - Phone:309-831-8326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000139246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL238.000139OtherSTATE OF ILLINOIS REGISTRATION NUMBER