Provider Demographics
NPI:1225338403
Name:RONALD C SIROIS MD PA
Entity Type:Organization
Organization Name:RONALD C SIROIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICEMANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-771-7620
Mailing Address - Street 1:4701 N FEDERAL HWY
Mailing Address - Street 2:SUITE C 10
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4608
Mailing Address - Country:US
Mailing Address - Phone:954-771-7620
Mailing Address - Fax:954-771-5665
Practice Address - Street 1:4701 N FEDERAL HWY
Practice Address - Street 2:SUITE C 10
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4608
Practice Address - Country:US
Practice Address - Phone:954-771-7620
Practice Address - Fax:954-771-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42798208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1326072562OtherNPI 1
FLD27807Medicare UPIN