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Individual

DR. RONNY SANTOSA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
8428A
WY
207R00000X
Internal Medicine Physician
D50860
MD
207R00000X
Internal Medicine Physician
Primary
MD167344
OR

Other

Enumeration date
11/29/2006
Last updated
10/24/2019
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