Provider Demographics
NPI:1700022878
Name:LONGWAY, RALPH ERVEST (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ERVEST
Last Name:LONGWAY
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:P.O. BOX 190
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:CA
Mailing Address - Zip Code:92318
Mailing Address - Country:US
Mailing Address - Phone:909-796-8454
Mailing Address - Fax:
Practice Address - Street 1:26560 HURON ST.
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-796-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00005763207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology