Provider Demographics
NPI:1467773093
Name:POOLE, RONALD DALE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DALE
Last Name:POOLE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 80
Mailing Address - Street 2:UNIT 5267, 18 AMDS/CC
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96368-5267
Mailing Address - Country:US
Mailing Address - Phone:979-530-4434
Mailing Address - Fax:
Practice Address - Street 1:PSC 80
Practice Address - Street 2:UNIT 5267, 18 AMDS/CC
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368-5267
Practice Address - Country:US
Practice Address - Phone:979-530-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025897207Q00000X, 2083A0100X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry