Provider Demographics
NPI:1871558098
Name:RONAY, GARY (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:RONAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 EICHENFELD DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5984
Mailing Address - Country:US
Mailing Address - Phone:813-684-7707
Mailing Address - Fax:813-653-4584
Practice Address - Street 1:503 EICHENFELD DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5984
Practice Address - Country:US
Practice Address - Phone:813-684-7707
Practice Address - Fax:813-653-4584
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046249174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041826900Medicaid
FL30805OtherBCBS
FLD54133Medicare UPIN
FL30805Medicare ID - Type Unspecified