Provider Demographics
NPI:1114135977
Name:RALLS, JOHN GREEL JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREEL
Last Name:RALLS
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 BAYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-6329
Mailing Address - Country:US
Mailing Address - Phone:850-432-4343
Mailing Address - Fax:850-429-7444
Practice Address - Street 1:641 BAYOU BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-6329
Practice Address - Country:US
Practice Address - Phone:850-432-4343
Practice Address - Fax:850-429-7444
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL121213ES0131X
FLPO-1815213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T90786Medicare UPIN
FL87975Medicare ID - Type Unspecified