Basic Information
| Provider Information | |||||||||
| NPI: | 1497719710 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RON ARISON MD PL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2438 E COMMERCIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333084040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547726740 | ||||||||
| FaxNumber: | 9547726703 | ||||||||
| Practice Location | |||||||||
| Address1: | 2438 E COMMERCIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333084040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547726740 | ||||||||
| FaxNumber: | 9547726703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 10/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | ARISON | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9547726740 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME42608 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | DA4470 | 01 | FL | RAILROAD MEDICARE | OTHER | 34799 | 01 | FL | BLUE CROSS/BLUE SHIELD | OTHER | 267416500 | 05 | FL | MEDICAID |