Provider Demographics
NPI:1063450773
Name:ZAGHA, RALPH (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:ZAGHA
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 1:2951 NW 49TH AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1600
Mailing Address - Country:US
Mailing Address - Phone:954-652-0246
Mailing Address - Fax:954-652-0471
Practice Address - Street 1:2951 NW 49TH AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1600
Practice Address - Country:US
Practice Address - Phone:954-652-0246
Practice Address - Fax:954-652-0471
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME95299208800000X
MA215117208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology