Healthcare Provider Details

I. General information

NPI: 1649380437
Provider Name (Legal Business Name): RONALD FORREST KOURY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8761 PERIMETER PARK BLVD SUITE 106
JACKSONVILLE FL
32216-1106
US

IV. Provider business mailing address

12955 LONGVIEW CIR
JACKSONVILLE FL
32223-2653
US

V. Phone/Fax

Practice location:
  • Phone: 904-641-6628
  • Fax: 904-641-6638
Mailing address:
  • Phone: 904-703-5754
  • Fax: 904-880-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS 8090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: