Provider Demographics
NPI:1609851245
Name:RONALDSON, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:RONALDSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-9265
Mailing Address - Fax:
Practice Address - Street 1:8725 N WICKHAM RD STE 302
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2240
Practice Address - Country:US
Practice Address - Phone:321-434-9265
Practice Address - Fax:321-434-9264
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME50860207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049656100Medicaid
FLP01164189OtherRR MEDICARE
FL07500ZOtherMEDICARE HF
D61520Medicare UPIN