1851505481 NPI number — MR. RALPH EDWARD PENDERGRAPH II

Table of content: MR. RALPH EDWARD PENDERGRAPH II (NPI 1851505481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851505481 NPI number — MR. RALPH EDWARD PENDERGRAPH II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENDERGRAPH
Provider First Name:
RALPH
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851505481
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5230 N ORANGE BLOSSOM TRL
Provider Second Line Business Mailing Address:
#306
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32810-4769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-926-5006
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5230 N ORANGE BLOSSOM TRL
Provider Second Line Business Practice Location Address:
#306
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32810-4769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-926-5006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com