Healthcare Provider Details

I. General information

NPI: 1205894425
Provider Name (Legal Business Name): RONALD EMERICK JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 S JEFFERSON ST
PERRY FL
32348-5611
US

IV. Provider business mailing address

13929 NW 166TH TER
ALACHUA FL
32615-8175
US

V. Phone/Fax

Practice location:
  • Phone: 850-584-2141
  • Fax: 850-838-2140
Mailing address:
  • Phone: 850-559-5989
  • Fax: 850-838-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS9746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: