Provider Demographics
NPI:1962552448
Name:DEJESUS, RONALDO V (MD)
Entity type:Individual
Prefix:DR
First Name:RONALDO
Middle Name:V
Last Name:DEJESUS
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 1:41 CAMBRIDGE COURT
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093
Mailing Address - Country:US
Mailing Address - Phone:334-567-5626
Mailing Address - Fax:334-567-0855
Practice Address - Street 1:41 CAMBRIDGE COURT
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36093
Practice Address - Country:US
Practice Address - Phone:334-567-5626
Practice Address - Fax:334-567-0855
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00018352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051553029Medicaid
AL51553029OtherBLUE CROSS
AL51553029OtherBLUE CROSS
AL051553029Medicaid