Provider Demographics
NPI:1871533687
Name:URDANETA, RAMON A (MD)
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:A
Last Name:URDANETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10000 W COLONIAL DR
Mailing Address - Street 2:SUITE 393
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3400
Mailing Address - Country:US
Mailing Address - Phone:407-296-1954
Mailing Address - Fax:407-253-2582
Practice Address - Street 1:10000 W COLONIAL DR
Practice Address - Street 2:SUITE 393
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3400
Practice Address - Country:US
Practice Address - Phone:407-296-1954
Practice Address - Fax:407-253-2582
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84766207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13966OtherBCBS
FL264371500Medicaid
P00112402OtherRAILROAD MEDICARE
FL264371500Medicaid
P00112402OtherRAILROAD MEDICARE