Provider Demographics
NPI:1750317749
Name:MORRIS, RONNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
Last Name:MORRIS
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 1:2500 QUANTUM LAKES DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8324
Mailing Address - Country:US
Mailing Address - Phone:561-244-3643
Mailing Address - Fax:
Practice Address - Street 1:1424 COMMERCIAL PARK DR
Practice Address - Street 2:SUITE 3
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-6565
Practice Address - Country:US
Practice Address - Phone:863-683-5574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31322TMedicare ID - Type UnspecifiedMEDICARE #