Provider Demographics
NPI:1053596874
Name:RALPH, JONATHAN D (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:RALPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:333 NW 70TH AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2385
Mailing Address - Country:US
Mailing Address - Phone:954-731-2810
Mailing Address - Fax:954-791-9810
Practice Address - Street 1:333 NW 70TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2385
Practice Address - Country:US
Practice Address - Phone:954-731-2810
Practice Address - Fax:954-791-9810
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAME0036825207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93814Medicare PIN