Provider Demographics
NPI:1053706655
Name:RALSTON, AUBREY SHEA (MD)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:SHEA
Last Name:RALSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W CENTRAL AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2186
Mailing Address - Country:US
Mailing Address - Phone:316-321-2010
Mailing Address - Fax:316-321-8871
Practice Address - Street 1:700 W CENTRAL AVE STE 205
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042
Practice Address - Country:US
Practice Address - Phone:316-321-2010
Practice Address - Fax:316-321-8871
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-41288208D00000X
ARE-10606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201210480AMedicaid