Provider Demographics
NPI:1497741821
Name:RABIN, RALPH B (DPM)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:B
Last Name:RABIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13055 W MCDOWELL RD
Mailing Address - Street 2:SUITE G108
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6449
Mailing Address - Country:US
Mailing Address - Phone:623-846-9000
Mailing Address - Fax:623-846-4021
Practice Address - Street 1:13055 W MCDOWELL RD
Practice Address - Street 2:SUITE G108
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6449
Practice Address - Country:US
Practice Address - Phone:623-846-9000
Practice Address - Fax:623-846-4021
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ081213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0195110OtherBLUE CROSS BLUE SHIELD
AZ700535Medicaid
AZ612151800OtherDEPARTMENT OF LABOR
AZ480127653OtherMEDICARE RAILROAD
AZZ85020Medicare PIN
AZ6092010001Medicare NSC
AZZ85018Medicare PIN
AZAZ0195110OtherBLUE CROSS BLUE SHIELD