Individual
RONALD MARTIN MALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3800 EAST BAY DRIVE, EAST BAY MEDICAL CENTER, LARGO, FL 33771
(727) 539-0505
(727) 394-1804
Mailing address
13020 PARK BLVD, OAKHURST MEDICAL CLINIC, SEMIONLE, FL 33776
(727) 393-3404
(727) 394-1804
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
OS0003675
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2337655
AETNA
—
01
—
267070
AVMED
—
Enumeration date
07/10/2006
Last updated
12/27/2011
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