| Doctor Name: | RONALD MARTIN MALL |
| NPI Number: | 1083648703 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | OS0003675 |
| Business Practice Address: | 3800 East Bay Drive East Bay Medical Center Largo, FL - 33771 |
| Business Phone Number: | 7275390505 |
| Business Fax Number: | 7273941804 |
| Mailing Address: | 13020 Park Blvd, Oakhurst Medical Clinic SEMIONLE |
| State: | FL |
| Postal Code: | 33776 |
| Phone Number: | 7273933404 |
| Fax Number: | 7273941804 |
| NPI Enumeration Date: | 07/10/2006 |
| NPI Last Update Date: | 12/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | OS0003675 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |