=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528115201
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICARDO REGALADO RAMOS M,D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2007
-----------------------------------------------------
Last Update Date | 01/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 SHIRCLIFF WAY DEPT OF PATHOLOGY
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32204-4748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-308-3886
-----------------------------------------------------
Fax | 904-308-2970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 144333
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32814-4333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-422-9831
-----------------------------------------------------
Fax | 407-206-1767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | ME73543
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ZC0500X
-----------------------------------------------------
Taxonomy Name | Cytopathology Physician
-----------------------------------------------------
License Number | ME73543
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207ZB0001X
-----------------------------------------------------
Taxonomy Name | Blood Banking & Transfusion Medicine Physician
-----------------------------------------------------
License Number | ME73543
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------