Provider Demographics
NPI:1780746545
Name:THOMAS, RONALD G (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:THOMAS
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:11579 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-7257
Practice Address - Country:US
Practice Address - Phone:904-262-3706
Practice Address - Fax:904-262-7583
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15962OtherBCBS
FL080169699OtherRAILROAD MEDICARE
FL15962Medicare ID - Type Unspecified
FL080169699OtherRAILROAD MEDICARE