Provider Demographics
NPI:1245248657
Name:RALPH, ROBERT ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLEN
Last Name:RALPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:605 N C 120 HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MOORESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28114-6713
Mailing Address - Country:US
Mailing Address - Phone:828-453-0703
Mailing Address - Fax:828-453-0835
Practice Address - Street 1:605 N C 120 HIGHWAY
Practice Address - Street 2:
Practice Address - City:MOORESBORO
Practice Address - State:NC
Practice Address - Zip Code:28114-6713
Practice Address - Country:US
Practice Address - Phone:828-453-0703
Practice Address - Fax:828-453-0835
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400326207Q00000X
SC18038207Q00000X
MI4301050764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A8361OtherMEDCOST
080171131OtherMEDICARE RAILROAD
NC8912898Medicaid
NC12898OtherBCBS
A8361OtherMEDCOST
NC12898OtherBCBS