Provider Demographics
NPI:1346219698
Name:DEMATTEIS, RALPH ANGELO (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ANGELO
Last Name:DEMATTEIS
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 1:1900 72ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4716
Mailing Address - Country:US
Mailing Address - Phone:727-527-8354
Mailing Address - Fax:727-525-3867
Practice Address - Street 1:2191 9TH AVE N
Practice Address - Street 2:SUITE 110
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7146
Practice Address - Country:US
Practice Address - Phone:727-322-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME212552086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054100100Medicaid
FL054100100Medicaid
FL52842ZMedicare PIN