Provider Demographics
NPI:1366459430
Name:BRESLAW, RALPH BARRY (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:BARRY
Last Name:BRESLAW
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 1:9868 S STATE ROAD 7 STE 300
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-4475
Mailing Address - Country:US
Mailing Address - Phone:561-272-1234
Mailing Address - Fax:561-274-2060
Practice Address - Street 1:9868 S STATE ROAD 7 STE 300
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-4475
Practice Address - Country:US
Practice Address - Phone:561-272-1234
Practice Address - Fax:561-274-2060
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300426100Medicaid
G93595Medicare UPIN
FL46766Medicare ID - Type Unspecified