Healthcare Provider Details

I. General information

NPI: 1629062112
Provider Name (Legal Business Name): RONALD GERALD DALRYMPLE P.H.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13180 N CLEVELAND AVE STE 312
N FORT MYERS FL
33903-6231
US

IV. Provider business mailing address

PO BOX 4466
FORT MYERS FL
33918-4466
US

V. Phone/Fax

Practice location:
  • Phone: 239-887-8999
  • Fax:
Mailing address:
  • Phone: 239-887-8999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3006
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0006631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: