Provider Demographics
NPI:1497735039
Name:ALI, RONNIE (DO)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
Last Name:ALI
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 1:11564 STANTON CIR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-6156
Mailing Address - Country:US
Mailing Address - Phone:228-896-1016
Mailing Address - Fax:228-354-0088
Practice Address - Street 1:11564 STANTON CIR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-6156
Practice Address - Country:US
Practice Address - Phone:228-896-1016
Practice Address - Fax:228-354-0088
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0009111207P00000X
MS16596207P00000X
TNDO0000001749207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272211900Medicaid
TN3319626Medicaid
MSP00411844OtherRAILROAD MEDICARE
MS00121559Medicaid
FLP00239565OtherRRMCR
FL48468OtherBCBS
FLP00239565OtherRRMCR
FL272211900Medicaid
MS930005041Medicare PIN
MSG38999Medicare UPIN
FL48468OtherBCBS
MSP00411844OtherRAILROAD MEDICARE