Provider Demographics
NPI:1881968162
Name:NATHAN, RONALD GEORGE
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GEORGE
Last Name:NATHAN
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 1:2150 E CERRADA NOPAL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4120
Mailing Address - Country:US
Mailing Address - Phone:520-299-4631
Mailing Address - Fax:
Practice Address - Street 1:2150 E CERRADA NOPAL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-4120
Practice Address - Country:US
Practice Address - Phone:520-299-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ114722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry