Provider Demographics
NPI:1346208212
Name:HADAM, RONALD TERRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:TERRY
Last Name:HADAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2835 W DE LEON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-5518
Mailing Address - Country:US
Mailing Address - Phone:813-254-4747
Mailing Address - Fax:941-795-4892
Practice Address - Street 1:4207 59TH STREET W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-6663
Practice Address - Country:US
Practice Address - Phone:941-792-8184
Practice Address - Fax:941-795-4892
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1502213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4535511OtherAETNA
FL87802OtherBCBS
FL593244840OtherHUMANA
FLPO1502OtherSTATE LICENSE NUMBER
FL4535511OtherAETNA
FL4682150001Medicare NSC