Provider Demographics
NPI:1962814491
Name:WHALLON, RALPH SAMUEL II (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:SAMUEL
Last Name:WHALLON
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:7500 N DREAMY DRAW DR STE 145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4668
Mailing Address - Country:US
Mailing Address - Phone:480-882-4545
Mailing Address - Fax:480-882-5814
Practice Address - Street 1:8705 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3909
Practice Address - Country:US
Practice Address - Phone:480-882-4545
Practice Address - Fax:480-946-6997
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2023-03-01
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Provider Licenses
StateLicense IDTaxonomies
AZ52386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ280191Medicaid