Provider Demographics
NPI:1003891433
Name:RALSTON, JAMES G (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:G
Last Name:RALSTON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:65 MEDICAL PARK BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-8428
Mailing Address - Country:US
Mailing Address - Phone:318-473-9958
Mailing Address - Fax:318-443-6935
Practice Address - Street 1:65 MEDICAL PARK BLVD
Practice Address - Street 2:STE 101
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-8428
Practice Address - Country:US
Practice Address - Phone:318-473-9958
Practice Address - Fax:318-443-6935
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2013-05-16
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Provider Licenses
StateLicense IDTaxonomies
LA016869207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1367494Medicaid
B64202Medicare UPIN
LA1367494Medicaid