Provider Demographics
NPI:1770585754
Name:KNIPE, RONALD CHARLES (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:CHARLES
Last Name:KNIPE
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 1:70 W GORE ST
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1124
Mailing Address - Country:US
Mailing Address - Phone:407-581-2888
Mailing Address - Fax:407-481-0073
Practice Address - Street 1:70 W GORE ST
Practice Address - Street 2:SUITE 200A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1124
Practice Address - Country:US
Practice Address - Phone:407-581-2888
Practice Address - Fax:407-481-0073
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065539207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23968OtherBLUE CROSS BL/SLD IND #
FLK2836OtherMEDICARE GRP #
FL45910OtherBCBSHLD GRP #
FL23968OtherBLUE CROSS BL/SLD IND #
FL23968AMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #