Provider Demographics
NPI:1316902679
Name:MOORE, RONALD JASON (PA-C)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JASON
Last Name:MOORE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 SE 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-3849
Mailing Address - Country:US
Mailing Address - Phone:352-598-4469
Mailing Address - Fax:
Practice Address - Street 1:400 CELEBRATION PL
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:352-598-4469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102945363AM0700X, 363AS0400X, 363A00000X
GA13064363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292533800Medicaid
FLY04L4OtherBCBS OF FL
FLP00414081OtherRR MEDICARE
FLP00702090OtherRR MEDICARE
FLU4075OtherBCBS
FLU4075LMedicare PIN
FLU4075OtherBCBS
FLY04L4OtherBCBS OF FL
FL292533800Medicaid
FLP00702090OtherRR MEDICARE
FLU4075RMedicare PIN
FLU4075UMedicare PIN
FLU4075WMedicare PIN
FLU4075Medicare PIN