Provider Demographics
NPI: | 1942306220 |
---|---|
Name: | URTON, RONALD JAMES (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | RONALD |
Middle Name: | JAMES |
Last Name: | URTON |
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: | 291 SOUTHALL LANE |
Mailing Address - Street 2: | |
Mailing Address - City: | MAITLAND |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32751 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 407-667-0444 |
Mailing Address - Fax: | 407-667-4338 |
Practice Address - Street 1: | 10000 W COLONIAL DR |
Practice Address - Street 2: | |
Practice Address - City: | OCOEE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34761-3400 |
Practice Address - Country: | US |
Practice Address - Phone: | 407-667-0444 |
Practice Address - Fax: | 407-667-4338 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-15 |
Last Update Date: | 2014-12-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME118574 | 207L00000X |
UT | 870911-1105 | 207L00000X |
AZ | 35931 | 2083A0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | |
No | 2083A0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 012365300 | Medicaid | |
FL | 14VT7 | Other | BCBS |
FL | 14VT7 | Other | BCBS |