Provider Demographics
NPI:1518389261
Name:MENNEMEYER, RALPH PAUL (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:PAUL
Last Name:MENNEMEYER
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 1:145 N ROBY FARM RD
Mailing Address - Street 2:
Mailing Address - City:ROCHEPORT
Mailing Address - State:MO
Mailing Address - Zip Code:65279-9437
Mailing Address - Country:US
Mailing Address - Phone:573-698-2828
Mailing Address - Fax:
Practice Address - Street 1:145 N ROBY FARM RD
Practice Address - Street 2:
Practice Address - City:ROCHEPORT
Practice Address - State:MO
Practice Address - Zip Code:65279-9437
Practice Address - Country:US
Practice Address - Phone:573-698-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6040207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology