Healthcare Provider Details

I. General information

NPI: 1609851245
Provider Name (Legal Business Name): JAMES M. RONALDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 N WICKHAM RD
MELBOURNE FL
32940-2239
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-9265
  • Fax: 321-434-9264
Mailing address:
  • Phone: 321-434-9265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME50860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: