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Individual

DR. RONALD D FUDALA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DC,DACAN

Contact information

Practice address
1301 PLANTATION ISLAND DR S, SUITE 402 A, SAINT AUGUSTINE, FL 32080-3108
(904) 471-4744
(901) 471-4745
Mailing address
1301 PLANTATION ISLAND DR S, SUITE 402A, SAINT AUGUSTINE, FL 32080-3108
(904) 471-4744
(904) 471-4745

Taxonomy

Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
1317
OH
111NN0400X
Neurology Chiropractor
Primary
CH10979
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000206217
ANTHEM
01
2501109
AETNA
01
44-00470
UNITED HEALTHCARE
Enumeration date
08/31/2006
Last updated
02/05/2015
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