MEDICARE: RONALD DALE POOLE MD, MPH

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	207Q00000X	Family Medicine Physician	025897	GA
2	2083A0100X	Aerospace Medicine Physician	025897	GA
3	2084P0800X	Psychiatry Physician	025897	GA

General Provider Information

NPI Number	:	1467773093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD DALE POOLE MD, MPH

Provider Business Mailing Address
First Line	:	PSC 80
Second Line	:	UNIT 5267, 18 AMDS/CC
City	:	APO
State	:	AP
Zip	:	96368-5267
Country	:	US
Telephone Number	:	979-530-4434
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 80
Second Line	:	UNIT 5267, 18 AMDS/CC
City	:	APO
State	:	AP
Zip	:	96368-5267
Country	:	US
Telephone Number	:	979-530-4434
Fax Number	:

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	06/17/2010

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