Provider Demographics
NPI:1962467654
Name:REUDINK, RONALD CHRISTOPHER (PA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:CHRISTOPHER
Last Name:REUDINK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1990
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423-1990
Mailing Address - Country:US
Mailing Address - Phone:352-746-2663
Mailing Address - Fax:
Practice Address - Street 1:950 N AVALON WAY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-6004
Practice Address - Country:US
Practice Address - Phone:352-746-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101954363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00093828OtherRAILROAD MEDICARE
FLP68686Medicare UPIN
FLE7974CMedicare PIN