Provider Demographics
NPI:1477500494
Name:RINGENBERG, RAE E (MD)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:E
Last Name:RINGENBERG
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 1:203 N PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4101
Mailing Address - Country:US
Mailing Address - Phone:407-886-1300
Mailing Address - Fax:407-886-1305
Practice Address - Street 1:203 N PARK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4101
Practice Address - Country:US
Practice Address - Phone:407-886-1300
Practice Address - Fax:407-886-1305
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46727OtherBCBS
D95612Medicare UPIN
FL46727ZMedicare PIN