Healthcare Provider Details

I. General information

NPI: 1063510592
Provider Name (Legal Business Name): RONALD T GARRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 GOODLETTE ROAD SUITE 202
NAPLES FL
34102
US

IV. Provider business mailing address

1112 GOODLETTE ROAD SUITE 202
NAPLES FL
34102
US

V. Phone/Fax

Practice location:
  • Phone: 239-692-8495
  • Fax: 239-692-8499
Mailing address:
  • Phone: 239-692-8495
  • Fax: 239-692-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME86639
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME86639
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME86639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: