Provider Demographics
NPI:1124213467
Name:BUNDY, RALPH LAWSON (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:LAWSON
Last Name:BUNDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15 SURFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-2353
Mailing Address - Country:US
Mailing Address - Phone:386-441-0141
Mailing Address - Fax:954-301-7885
Practice Address - Street 1:15 SURFSIDE DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-2353
Practice Address - Country:US
Practice Address - Phone:386-441-0141
Practice Address - Fax:954-301-7885
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0044414207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology