Provider Demographics
NPI:1407875016
Name:RONDEROS, JUAN FELIX (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:FELIX
Last Name:RONDEROS
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 1:8096 TWIN BEECH RD STE 250
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-7194
Mailing Address - Country:US
Mailing Address - Phone:251-279-6520
Mailing Address - Fax:251-279-6523
Practice Address - Street 1:8096 TWIN BEECH RD STE 250
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-7194
Practice Address - Country:US
Practice Address - Phone:251-279-6520
Practice Address - Fax:251-279-6523
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-48215207T00000X
AL12906207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51527898OtherBC
AL009993025Medicaid
C70359Medicare UPIN
051527898Medicare PIN