Provider Demographics
NPI:1043266281
Name:BUCKLEY, RALPH STOWELL (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:STOWELL
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 HOSPITAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2043
Mailing Address - Country:US
Mailing Address - Phone:251-990-9500
Mailing Address - Fax:251-990-9501
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE D-330
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-607-9797
Practice Address - Fax:251-607-9761
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025243207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01886869Medicaid
MS01886869Medicaid