Provider Demographics
NPI:1396792024
Name:DAVIS, RONALD G (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:DAVIS
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 1:1245 W FAIRBANKS AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4878
Mailing Address - Country:US
Mailing Address - Phone:407-293-1122
Mailing Address - Fax:407-253-2170
Practice Address - Street 1:1245 W FAIRBANKS AVE STE 305
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4878
Practice Address - Country:US
Practice Address - Phone:407-293-1122
Practice Address - Fax:833-428-3595
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME816622084N0402X
MA783172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262510500Medicaid
FL58045Medicare PIN
FL262510500Medicaid