Provider Demographics
NPI:1114917101
Name:RALPH B MONNETT JR MD PA
Entity Type:Organization
Organization Name:RALPH B MONNETT JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-589-8111
Mailing Address - Street 1:14410 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3237
Mailing Address - Country:US
Mailing Address - Phone:772-589-8111
Mailing Address - Fax:772-589-7561
Practice Address - Street 1:14410 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3237
Practice Address - Country:US
Practice Address - Phone:772-589-8111
Practice Address - Fax:772-589-7561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0653171OtherAETNA HMO
FL38814OtherBCBS PROVIDER NUMBER
FL8720359OtherAETNA PPO
FL0499360OtherGHI GROUP PROVIDER NUMBER
FLK1061Medicare PIN
FL4508120001Medicare NSC
FL38814OtherBCBS PROVIDER NUMBER
FL4508120001Medicare PIN