Provider Demographics
NPI:1326007584
Name:RONDON, ELISEO J (MD)
Entity Type:Individual
Prefix:
First Name:ELISEO
Middle Name:J
Last Name:RONDON
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 1:3501 JOHNSON ST
Mailing Address - Street 2:DEPT. OF CRITICAL CARE MEDICINE
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5421
Mailing Address - Country:US
Mailing Address - Phone:954-987-2020
Mailing Address - Fax:954-965-5396
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:DEPT. OF CRITICAL CARE MEDICINE
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-987-2020
Practice Address - Fax:954-965-5396
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96741207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274915700Medicaid