Provider Demographics
NPI:1437143187
Name:FAUER, RONALD BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BARRY
Last Name:FAUER
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1200 E BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2134
Practice Address - Country:US
Practice Address - Phone:954-463-6408
Practice Address - Fax:954-463-1858
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32413204C00000X
FLME0032413208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000056842, XOtherHUMANA
FL4069055OtherAETNA
FL2529OtherDIMENSIONS
FLP00731865OtherRAIL ROAD MEDICARE
FLP0003142OtherFLORIDA HEALTHCARE PLUS
FL002529OtherNEIGHBORHOOD HEALTH PARTNERSHIP
FL205812OtherAVMED
FL93504OtherBCBS OF FL
FL0377015-00Medicaid
FL0925624OtherCIGNA
FL11984OtherMEDICA
FLP00731865OtherRAIL ROAD MEDICARE
FL4069055OtherAETNA
FL93504XMedicare PIN