Provider Demographics
NPI:1023454170
Name:ANDERSON, RONALD E (LAC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 47922
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33743-7922
Mailing Address - Country:US
Mailing Address - Phone:727-593-4149
Mailing Address - Fax:
Practice Address - Street 1:9724 N ARMENIA AVE STE 400
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7550
Practice Address - Country:US
Practice Address - Phone:813-464-0967
Practice Address - Fax:813-933-0968
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT470171100000X
FLAP3541171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist