Provider Demographics
NPI:1376535138
Name:EASTRIDGE, RALPH ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:ROBERT
Last Name:EASTRIDGE
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 1:3355 BURNS RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-622-4900
Mailing Address - Fax:561-622-0186
Practice Address - Street 1:3355 BURNS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-622-4900
Practice Address - Fax:561-622-0186
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22718208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1725514OtherCIGNA
FL4600807OtherAETNA
FLP1695816OtherOXFORD HEALTH PLANS
FLP00343456OtherRAILROAD MEDICARE
FL50778ZMedicare ID - Type Unspecified
FLP1695816OtherOXFORD HEALTH PLANS
D85883Medicare UPIN