Provider Demographics
NPI:1730261736
Name:MCRONALD, ROSS E (MD)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:E
Last Name:MCRONALD
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 1:5917 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462
Mailing Address - Country:US
Mailing Address - Phone:561-432-0007
Mailing Address - Fax:561-966-9793
Practice Address - Street 1:5917 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462
Practice Address - Country:US
Practice Address - Phone:561-432-0007
Practice Address - Fax:561-966-9793
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C55131Medicare UPIN
46750Medicare ID - Type Unspecified