Provider Demographics
NPI:1063487486
Name:MAYBERRY, RALPH ESKER (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:ESKER
Last Name:MAYBERRY
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 1:1800 E WILCOX DR
Mailing Address - Street 2:FAMILY HEALTH CENTER OF SIERRA VISTA
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2756
Mailing Address - Country:US
Mailing Address - Phone:520-459-3116
Mailing Address - Fax:520-459-7397
Practice Address - Street 1:1800 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2756
Practice Address - Country:US
Practice Address - Phone:520-459-3116
Practice Address - Fax:520-459-7397
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ286444Medicaid
AZCH7902OtherRAILROAD MEDICARE
AZ3336424011OtherCIGNA
AZ4114162OtherAETNA
AZ1Z4100OtherHEALTHNET
AZAZ0262820OtherBCBS ARIZONA
AZ08001448OtherUNITED HEALTHCARE
AZ286444Medicaid
AZ4114162OtherAETNA