Provider Demographics
NPI:1396046892
Name:RALPH P PAGE MD INC
Entity type:Organization
Organization Name:RALPH P PAGE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-631-1400
Mailing Address - Street 1:1026 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2132
Mailing Address - Country:US
Mailing Address - Phone:321-631-1400
Mailing Address - Fax:321-632-0866
Practice Address - Street 1:1026 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2132
Practice Address - Country:US
Practice Address - Phone:321-631-1400
Practice Address - Fax:321-632-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036157700Medicaid
D63168Medicare UPIN
FL94228Medicare PIN