Provider Demographics
NPI:1356665061
Name:GARY RONAY MD PA
Entity Type:Organization
Organization Name:GARY RONAY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RONAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-684-7707
Mailing Address - Street 1:503 EICHENFELD DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5984
Mailing Address - Country:US
Mailing Address - Phone:813-684-7707
Mailing Address - Fax:813-653-4584
Practice Address - Street 1:503 EICHENFELD DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5984
Practice Address - Country:US
Practice Address - Phone:813-684-7707
Practice Address - Fax:813-653-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046249208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041826900Medicaid
FL30805OtherBCBS
FL30805Medicare PIN
FL30805OtherBCBS