Provider Demographics
NPI:1972566727
Name:CAMPANALE, RALPH P II (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:P
Last Name:CAMPANALE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-0777
Mailing Address - Country:US
Mailing Address - Phone:208-772-5882
Mailing Address - Fax:208-762-7543
Practice Address - Street 1:180 W FIRST STREET SUITE 301
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-726-3707
Practice Address - Fax:208-726-4817
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM4961208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID020024438OtherRAILROAD MEDICARE
IDD3513OtherBLUE CROSS OF ID
ID000010000420OtherREGENCE BLUE SHIELD
ID002699100Medicaid
IDD3513OtherBLUE CROSS OF ID
ID020024438OtherRAILROAD MEDICARE