=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174599476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD SHANE DAY D.O., M.P.H.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2006
-----------------------------------------------------
Last Update Date | 04/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 LIELMANIS AVE
-----------------------------------------------------
City | HURLBURT FIELD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32544-5613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-881-3307
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47 HUME DR
-----------------------------------------------------
City | HURLBURT FIELD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32544-1039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-859-2748
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0011X
-----------------------------------------------------
Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
-----------------------------------------------------
License Number | 0-241
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2083P0500X
-----------------------------------------------------
Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
-----------------------------------------------------
License Number | O-245
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2083A0100X
-----------------------------------------------------
Taxonomy Name | Aerospace Medicine Physician
-----------------------------------------------------
License Number | O-245
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------