MEDICARE: DR. LUIS RONALD PERNIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	4104	AL

General Provider Information

NPI Number	:	1174504336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS RONALD PERNIA M.D.

Provider Business Mailing Address
First Line	:	1325 MCFARLAND BLVD
Second Line	:	SUITE 201
City	:	NORTHPORT
State	:	AL
Zip	:	35476-3270
Country	:	US
Telephone Number	:	205-330-8820
Fax Number	:	205-333-2515

Provider Business Practice Location Address
First Line	:	1325 MCFARLAND BLVD
Second Line	:	SUITE 201
City	:	NORTHPORT
State	:	AL
Zip	:	35476-3270
Country	:	US
Telephone Number	:	205-330-8820
Fax Number	:	205-333-2515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	12/05/2012

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