Provider Demographics
NPI:1174581888
Name:STANISH, RONALD JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JOSEPH
Last Name:STANISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 ALOMA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3330
Mailing Address - Country:US
Mailing Address - Phone:407-679-9222
Mailing Address - Fax:407-679-9061
Practice Address - Street 1:2304 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3330
Practice Address - Country:US
Practice Address - Phone:407-679-9222
Practice Address - Fax:407-679-9061
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593339550OtherWINTER PARK FAMILY HEALTH CENTER, INC TAX ID
D55540Medicare UPIN
48983Medicare ID - Type Unspecified