MEDICARE: RONNIE JAMES TOMLINSON JR.

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	MA68369	FL

General Provider Information

NPI Number	:	1366705873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONNIE JAMES TOMLINSON JR.

Provider Business Mailing Address
First Line	:	10428 1ST ST
Second Line	:
City	:	WHITE SPRINGS
State	:	FL
Zip	:	32096-1918
Country	:	US
Telephone Number	:	386-234-0810
Fax Number	:

Provider Business Practice Location Address
First Line	:	10428 1ST ST
Second Line	:
City	:	WHITE SPRINGS
State	:	FL
Zip	:	32096-1918
Country	:	US
Telephone Number	:	386-234-0810
Fax Number	:

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

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	06/19/2012

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