1154467736 NPI number — RONNIE E SUGGS DPM PA

Table of content: (NPI 1154467736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154467736 NPI number — RONNIE E SUGGS DPM PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONNIE E SUGGS DPM PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154467736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1609 COLLEEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLE ISLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32809-6887
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-240-0002
Provider Business Mailing Address Fax Number:
407-240-0088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1609 COLLEEN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLE ISLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32809-6887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-240-0002
Provider Business Practice Location Address Fax Number:
407-240-0088
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SUGGS
Authorized Official First Name:
RONNIE
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
407-240-0002

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO2451 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 390230700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480021182 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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