Provider Demographics
NPI:1265409239
Name:RALLS, GEORGE (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:RALLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 VINELAND ROAD
Mailing Address - Street 2:SUITE A-11
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811
Mailing Address - Country:US
Mailing Address - Phone:407-650-4031
Mailing Address - Fax:407-318-3288
Practice Address - Street 1:4401 VINELAND ROAD
Practice Address - Street 2:SUITE A-11
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811
Practice Address - Country:US
Practice Address - Phone:407-650-4031
Practice Address - Fax:407-318-3288
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0082238207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01676OtherBCBS
FL01676YMedicare ID - Type UnspecifiedMEDICARE
FL01676OtherBCBS