Provider Demographics
NPI:1134142003
Name:CATHCART, RONALD (MD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:CATHCART
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 1:1495 N HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6527
Mailing Address - Country:US
Mailing Address - Phone:321-253-0846
Mailing Address - Fax:321-253-1004
Practice Address - Street 1:1495 N HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6527
Practice Address - Country:US
Practice Address - Phone:321-253-0846
Practice Address - Fax:321-253-1004
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057661100Medicaid
FL36216WMedicare ID - Type Unspecified
FL057661100Medicaid