Provider Demographics
NPI:1780790691
Name:BATHAW, RONALD (MD)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:BATHAW
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:PO BOX 35-2077
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32135-2077
Mailing Address - Country:US
Mailing Address - Phone:386-586-2234
Mailing Address - Fax:386-586-2884
Practice Address - Street 1:80 PINNACLES DR
Practice Address - Street 2:BUILDING B, SUITE 700
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2323
Practice Address - Country:US
Practice Address - Phone:386-586-2234
Practice Address - Fax:386-586-2884
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046366207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
156214BATOtherUHC
5873158OtherAETNA
64550Medicare ID - Type Unspecified
5873158OtherAETNA