Healthcare Provider Details

I. General information

NPI: 1053450759
Provider Name (Legal Business Name): RAMON ISALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 BABCOCK ST NE STE 1
PALM BAY FL
32905-4616
US

IV. Provider business mailing address

PO BOX 1137
MELBOURNE FL
32902-1137
US

V. Phone/Fax

Practice location:
  • Phone: 321-676-5996
  • Fax: 321-676-5926
Mailing address:
  • Phone: 321-952-9696
  • Fax: 321-952-7937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME61307
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: