Provider Demographics
NPI:1417989633
Name:MALLONEE, RONALD C (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:MALLONEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 N SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3330
Mailing Address - Country:US
Mailing Address - Phone:407-205-3132
Mailing Address - Fax:
Practice Address - Street 1:632 N SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3330
Practice Address - Country:US
Practice Address - Phone:407-205-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD93060Medicare UPIN
FL57329AMedicare ID - Type Unspecified