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General NPI Number Information
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NPI Number | 1497948996
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Entity Type | Individual
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Provider Name | RONALD M CHASE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 32910 LAKESHORE DR
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City | TAVARES
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State | FL
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Zip | 32778-5013
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Country | US
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Telephone | 917-208-5366
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Fax |
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Provider Business Mailing Address
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Address Line | 32910 LAKESHORE DR
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City | TAVARES
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State | FL
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Zip | 32778-5013
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Country | US
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Telephone | 917-208-5366
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Fax |
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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 | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number | ME23083
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License Number State | FL
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