Provider Demographics
NPI:1942356621
Name:ACKERMAN, RONALD T SR (MD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:T
Last Name:ACKERMAN
Suffix:SR
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 1:603 VILLAGE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409
Mailing Address - Country:US
Mailing Address - Phone:561-683-1331
Mailing Address - Fax:561-683-4615
Practice Address - Street 1:603 VILLAGE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-683-1331
Practice Address - Fax:561-683-4615
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043294207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370055100Medicaid
D65269Medicare UPIN
FL61358YMedicare PIN