Provider Demographics
NPI:1285636472
Name:WILES, RONNIE D (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:D
Last Name:WILES
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 1:1619 CREIGHTON RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7152
Mailing Address - Country:US
Mailing Address - Phone:850-444-4700
Mailing Address - Fax:850-444-7497
Practice Address - Street 1:1619 CREIGHTON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7152
Practice Address - Country:US
Practice Address - Phone:850-444-4700
Practice Address - Fax:850-434-8144
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.22877207RN0300X
FLME78548207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALMD.22877OtherALABAMA MEDICAL LICENSE
FLME78548OtherFLORIDA MEDICAL LICENSURE
FL257082300Medicaid
FL46929TMedicare ID - Type Unspecified
ALMD.22877OtherALABAMA MEDICAL LICENSE
FL257082300Medicaid
G95781Medicare UPIN
FL46929TMedicare ID - Type Unspecified
FL257082300Medicaid