Provider Demographics
NPI:1689754590
Name:FAVILLE, RALPH J (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:J
Last Name:FAVILLE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:200 UNIVERSITY AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2507
Mailing Address - Country:US
Mailing Address - Phone:651-325-2121
Mailing Address - Fax:651-325-2122
Practice Address - Street 1:200 UNIVERSITY AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2507
Practice Address - Country:US
Practice Address - Phone:651-325-2121
Practice Address - Fax:651-325-2122
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-01-04
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Provider Licenses
StateLicense IDTaxonomies
MN198012080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
D79974Medicare UPIN
MN3700020165Medicare PIN