Provider Demographics
NPI:1265566004
Name:RALSTON, JAMES (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:RALSTON
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 1:5801 VIRGINIA PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5507
Mailing Address - Country:US
Mailing Address - Phone:972-548-0333
Mailing Address - Fax:
Practice Address - Street 1:5801 VIRGINIA PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5507
Practice Address - Country:US
Practice Address - Phone:972-548-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8933207N00000X, 207N00000X
GA059006207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
07BBSVJMedicare PIN