Ronald Martin Mall, DO

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

OS0003675 Issued in FL

Practice address

3800 East Bay Drive
East Bay Medical Center
Largo, FL 33771

Phone

(727) 539-0505

Fax

(727) 394-1804

NPI assigned

Jul 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Best Value Healthcare LLC

  • Internal Medicine Physician
  • Clearwater, FL
  • NPI 1790152015
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324944000000",
    "number": "1083648703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13020 PARK BLVD",
            "address_2": "OAKHURST MEDICAL CLINIC",
            "city": "SEMIONLE",
            "state": "FL",
            "postal_code": "33776",
            "telephone_number": "727-393-3404",
            "fax_number": "727-394-1804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 EAST BAY DRIVE",
            "address_2": "EAST BAY MEDICAL CENTER",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "33771",
            "telephone_number": "727-539-0505",
            "fax_number": "727-394-1804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALL",
        "first_name": "RONALD",
        "middle_name": "MARTIN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2011-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "OS0003675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2337655",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "267070",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scheri-Lyn A. Makombe, MD
• Miryam Makutonin, DO
• John James Malcom
• Ali Malik
• Ryan Malkiewicz, AU.D
• Rubaiya Mallay, D.O.
• Lesley Mallett, ARNP
• Scott Malone
• Christopher Philip Maly, D.D.S.
• Mufit Adam Mamo, MD

• General Practice Physician in Largo, FL
• Providers in Largo, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.