Provider Demographics
NPI:1194722520
Name:OPPENHEIM, RONALD EDWARD (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:EDWARD
Last Name:OPPENHEIM
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 1:1400 S ORLANDO AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5543
Mailing Address - Country:US
Mailing Address - Phone:407-645-3151
Mailing Address - Fax:407-645-2179
Practice Address - Street 1:1400 S ORLANDO AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5543
Practice Address - Country:US
Practice Address - Phone:407-645-3151
Practice Address - Fax:407-645-2179
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00422132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58918Medicare UPIN
24844Medicare ID - Type Unspecified