Healthcare Provider Details

I. General information

NPI: 1982629895
Provider Name (Legal Business Name): RUSSELL S RONSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BAPTIST WAY STE 3A
PENSACOLA FL
32503-2274
US

IV. Provider business mailing address

125 BAPTIST WAY STE 3A
PENSACOLA FL
32503-2274
US

V. Phone/Fax

Practice location:
  • Phone: 448-227-6500
  • Fax: 850-857-1747
Mailing address:
  • Phone: 448-227-6500
  • Fax: 850-857-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number25385
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME144419
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: