Provider Demographics
NPI:1063510592
Name:GARRY, RONALD T (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:T
Last Name:GARRY
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 1:1112 GOODLETTE ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102
Mailing Address - Country:US
Mailing Address - Phone:239-692-8495
Mailing Address - Fax:239-692-8499
Practice Address - Street 1:1112 GOODLETTE ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102
Practice Address - Country:US
Practice Address - Phone:239-692-8495
Practice Address - Fax:239-692-8499
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86639207RG0300X, 207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57693OtherBCBS PROVIDER #
FLG67448Medicare UPIN
FL266281700Medicaid
FL57693Medicare ID - Type UnspecifiedMEDICARE #