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General NPI Number Information
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NPI Number | 1285895334
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Entity Type | Individual
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Provider Name | RONNIE PRIDEMORE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2008
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 913 N DIXIE AVE
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2503
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Country | US
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Telephone | 877-783-6257
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Fax | 859-514-5521
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Provider Business Mailing Address
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Address Line | PO BOX 910530
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City | LEXINGTON
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State | KY
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Zip | 40591-0530
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Country | US
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Telephone | 877-783-6257
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Fax | 859-514-5521
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 48816
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License Number State | KY
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