Provider Demographics
NPI:1255373502
Name:BOGATIN, RONALD SCOTT (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:SCOTT
Last Name:BOGATIN
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 1:347 SHORE DR E
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3915
Mailing Address - Country:US
Mailing Address - Phone:727-729-0108
Mailing Address - Fax:
Practice Address - Street 1:347 SHORE DR E
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3915
Practice Address - Country:US
Practice Address - Phone:727-729-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044404207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042415300Medicaid
FL53794OtherBLUE SHIELD OF FL
FL042415300Medicaid
FLD21763Medicare UPIN