License Verification

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RALPH EUGENE MASSULLO JR

License Number: ME54469

Data As Of 12/22/2024

Profession
Medical Doctor
License
ME54469
License Status
CLEAR/Active
Qualifications
Dispensing Practitioner
License Expiration Date
1/31/2026
License Original Issue Date
10/20/1988
Address of Record
525 No Dacie Pt
525 NO DACIE
LECANTO, FL 34461-8547
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
9401 SW Hwy 200 9401 SW HWY 200
OCALA, FL 34481
Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date
BAILEY, CARLA RENEE Prescribing Physician Assistant Physician Assistant 9105058 1/1/2021
BONOMO, BRIAN KEITH Dispensing Physician Assistant Physician Assistant 9101264 1/1/2021
BONOMO, BRIAN KEITH Prescribing Physician Assistant Physician Assistant 9101264 1/1/2021
CHATHAM, KRISTY LYNN PA Prescribing Physician Assistant Physician Assistant 9102875 1/1/2021
SUNCOAST DERMATOLOGY & SKIN SURGERY CENT HCCE Health Care Clinic Establishment Permit 392 12/24/2008
SUNCOAST DERMATOLOGY & SKIN SURGERY CENT HCCE Health Care Clinic Establishment Permit 1636 3/3/2009

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 12/22/2024



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** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


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