Provider Demographics
NPI:1265597413
Name:TEMPLIN, RALPH WAYNE (DO)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:WAYNE
Last Name:TEMPLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 ASHLEY CT
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75752-6526
Mailing Address - Country:US
Mailing Address - Phone:270-556-0285
Mailing Address - Fax:903-677-6841
Practice Address - Street 1:3335 ASHLEY CT
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75752-6526
Practice Address - Country:US
Practice Address - Phone:270-556-0285
Practice Address - Fax:903-677-6841
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ39152085R0202X
KY022022085R0202X
MI51010120822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J7846Medicare PIN
E01383Medicare UPIN