Provider Demographics
NPI:1497755912
Name:HO, RONG D
Entity Type:Individual
Prefix:MR
First Name:RONG
Middle Name:D
Last Name:HO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 AVENUE C NE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4558
Mailing Address - Country:US
Mailing Address - Phone:863-293-1071
Mailing Address - Fax:863-295-9383
Practice Address - Street 1:306 AVENUE C NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4558
Practice Address - Country:US
Practice Address - Phone:863-293-1071
Practice Address - Fax:863-295-9383
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00236392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D56580Medicare UPIN
FL53552YMedicare ID - Type Unspecified