Provider Demographics
NPI:1346317088
Name:JEAN MARY, JEAN RONY (MD)
Entity Type:Individual
Prefix:
First Name:JEAN RONY
Middle Name:
Last Name:JEAN MARY
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 1:2501 E COMMERCIAL BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4127
Mailing Address - Country:US
Mailing Address - Phone:954-990-6180
Mailing Address - Fax:954-990-0173
Practice Address - Street 1:2501 E COMMERCIAL BLVD
Practice Address - Street 2:STE 212
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4127
Practice Address - Country:US
Practice Address - Phone:954-533-5700
Practice Address - Fax:954-306-8686
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME990922084P0800X, 207Q00000X, 2084P0800X
NY2183592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000478400Medicaid