Provider Demographics
NPI:1770569527
Name:PAGE, RALPH PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:PATRICK
Last Name:PAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:321-631-1404
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:321-631-1404
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0041617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036157700Medicaid
FL94228Medicare ID - Type Unspecified
FL036157700Medicaid