Healthcare Provider Details

I. General information

NPI: 1780629261
Provider Name (Legal Business Name): RAMON J PABALAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 DEL PRADO BLVD S EMERGENCY DEPARTMENT
CAPE CORAL FL
33990-2668
US

IV. Provider business mailing address

14050 NW 14TH ST SUITE 190
SUNRISE FL
33323-2865
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-6513
  • Fax: 239-574-0269
Mailing address:
  • Phone: 800-424-3672
  • Fax: 954-377-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME40952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: