Provider Demographics
NPI:1851505481
Name:PENDERGRAPH, RALPH EDWARD II
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:EDWARD
Last Name:PENDERGRAPH
Suffix:II
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 1:5230 N ORANGE BLOSSOM TRL
Mailing Address - Street 2:#306
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-4769
Mailing Address - Country:US
Mailing Address - Phone:407-926-5006
Mailing Address - Fax:
Practice Address - Street 1:5230 N ORANGE BLOSSOM TRL
Practice Address - Street 2:#306
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-4769
Practice Address - Country:US
Practice Address - Phone:407-926-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies