Provider Demographics
NPI:1689682825
Name:RYDELL, RALPH E (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:E
Last Name:RYDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RALPH
Other - Middle Name:E
Other - Last Name:RYDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:5106 N ARMENIA AVENUE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603
Mailing Address - Country:US
Mailing Address - Phone:813-879-8080
Mailing Address - Fax:813-879-3784
Practice Address - Street 1:5106 N ARMENIA AVENUE
Practice Address - Street 2:SUITE #1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603
Practice Address - Country:US
Practice Address - Phone:813-879-8080
Practice Address - Fax:813-879-3784
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0016444207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049803300Medicaid
FL29657Medicare ID - Type Unspecified
FL049803300Medicaid