Provider Demographics
NPI:1669413084
Name:KNOBLOCK, RONALD JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JOSEPH
Last Name:KNOBLOCK
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 1:11025 RCA CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4269
Mailing Address - Country:US
Mailing Address - Phone:561-383-3820
Mailing Address - Fax:855-369-2450
Practice Address - Street 1:7455 W WASHINGTON AVE STE 301
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:877-562-5227
Practice Address - Fax:702-938-9954
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10511207ZF0201X, 207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511109Medicaid
NVV102648Medicare PIN
NV100511109Medicaid