Provider Demographics
NPI:1780607093
Name:HALLAC, RALPH ROLAND (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ROLAND
Last Name:HALLAC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:621 GONDOLIERE AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6308
Mailing Address - Country:US
Mailing Address - Phone:786-431-5401
Mailing Address - Fax:786-431-5401
Practice Address - Street 1:9999 NE 2ND AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2352
Practice Address - Country:US
Practice Address - Phone:305-756-4400
Practice Address - Fax:305-756-4484
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA34540207RN0300X
FLME 97171207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55488Medicare UPIN