Provider Demographics
NPI:1659332310
Name:IMLAY, RALPH C B
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:C B
Last Name:IMLAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HARPER
Mailing Address - State:KS
Mailing Address - Zip Code:67058-1401
Mailing Address - Country:US
Mailing Address - Phone:620-896-7306
Mailing Address - Fax:620-896-7127
Practice Address - Street 1:700 W 13TH ST
Practice Address - Street 2:
Practice Address - City:HARPER
Practice Address - State:KS
Practice Address - Zip Code:67058-1401
Practice Address - Country:US
Practice Address - Phone:620-896-7306
Practice Address - Fax:620-896-7127
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0423877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100293000MMedicaid
KS100293000MMedicaid
KS104395Medicare ID - Type Unspecified