Provider Demographics
NPI:1508174038
Name:RALPH E RYDELL, M.D.P.A.
Entity Type:Organization
Organization Name:RALPH E RYDELL, M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:RYDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-879-8080
Mailing Address - Street 1:5106 N ARMENIA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1433
Mailing Address - Country:US
Mailing Address - Phone:813-879-8080
Mailing Address - Fax:813-879-3784
Practice Address - Street 1:5106 N ARMENIA AVE STE 1
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1433
Practice Address - Country:US
Practice Address - Phone:813-879-8080
Practice Address - Fax:813-879-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0016444207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD0231AMedicare PIN
FLD53662Medicare UPIN