Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | ME95141 | FL |
NPI | 1104977362 |
---|---|
Provider Name | Dr. Ronaldo A Calonje |
First Address | Tamarac, FL 33321-2979 |
Second Address | Tamarac, FL 33321-2979 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 09/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ME95141 | FLORIDA MEDICAL LICENSE (01) | FL |