Provider Demographics
NPI:1003818188
Name:PIMENTEL, RONNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
Last Name:PIMENTEL
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 1:2950 CLEVELAND CLINIC BLV BLVD
Mailing Address - Street 2:CLEVELAN CLINIC FLORIDA
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331
Mailing Address - Country:US
Mailing Address - Phone:309-762-5560
Mailing Address - Fax:309-762-7351
Practice Address - Street 1:2950 CLEVELAND CLINIC BLVD
Practice Address - Street 2:CLEVALAND CLINIC FLORIDA DEPARTMENT OF GASTROENTEROLOGY
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331
Practice Address - Country:US
Practice Address - Phone:309-762-5560
Practice Address - Fax:309-762-7351
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63413174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK27162Medicare UPIN