Provider Demographics
NPI:1376544684
Name:YARBROUGH, RONALD C (PHD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:C
Last Name:YARBROUGH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8616
Mailing Address - Country:US
Mailing Address - Phone:850-478-3888
Mailing Address - Fax:850-478-0914
Practice Address - Street 1:1576 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8616
Practice Address - Country:US
Practice Address - Phone:850-478-3888
Practice Address - Fax:850-478-0914
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2717103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103TC0700XOtherTAXONOMY MUMBER
FLPY2717OtherSTATE LICENSE INFORMATION