Provider Demographics
NPI:1457568222
Name:DIFORE, RALPH JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:JOSEPH
Last Name:DIFORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1717 SHIPYARD BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8023
Mailing Address - Country:US
Mailing Address - Phone:910-799-0110
Mailing Address - Fax:910-799-1958
Practice Address - Street 1:200 DOCTORS DR
Practice Address - Street 2:SUITE J
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6308
Practice Address - Country:US
Practice Address - Phone:910-799-0110
Practice Address - Fax:910-799-1958
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC31011207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928552Medicaid
NC561926376OtherWORKER'S COMP
NC28552OtherBLUE CROSS BLUE SHIELD NC
NC2016447Medicare ID - Type Unspecified
NCC83538Medicare UPIN