Provider Demographics
NPI:1831146141
Name:RYBACK, RALPH S (MD LP)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:S
Last Name:RYBACK
Suffix:
Gender:M
Credentials:MD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1415 PANTHER LN
Mailing Address - Street 2:#248
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-7874
Mailing Address - Country:US
Mailing Address - Phone:239-775-4500
Mailing Address - Fax:239-775-2990
Practice Address - Street 1:1303 HOMESTEAD RD N
Practice Address - Street 2:#102
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6049
Practice Address - Country:US
Practice Address - Phone:239-303-2700
Practice Address - Fax:239-303-2756
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME925632084P0800X
FLME 92563208D00000X
FLNPI1508179490261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
B94049Medicare UPIN
FL01529WMedicare PIN
FL01529Medicare ID - Type Unspecified