Active NPI
Ronald Warren Roudon, ATC RETIRED ,LAT
- Other Technician
- Kennedale, TX
National Provider Identifier
1871642801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- AT 0208
- Practice address
- 1403 Peggy LN
Kennedale, TX 76060-5832 - Phone
- (817) 478-3939
- NPI assigned
- Jan 9, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | AT 0208 | TX | Primary |
Addresses
Primary practice location
1403 Peggy LN
Kennedale, TX 76060-5832
Mailing address
1403 Peggy LN
Kennedale, TX 76060-5832
Phone (817) 478-3939
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT 0208 | TX | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871642801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1403 PEGGY LN",
"city": "KENNEDALE",
"state": "TX",
"postal_code": "760605832",
"telephone_number": "817-478-3939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1403 PEGGY LN",
"city": "KENNEDALE",
"state": "TX",
"postal_code": "760605832",
"telephone_number": "817-478-3939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUDON",
"first_name": "RONALD",
"middle_name": "WARREN",
"name_prefix": "Mr.",
"credential": "ATC RETIRED ,LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "TX",
"license": "AT 0208",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennedale, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.