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NPI Code Detail

MEDICARE: MR. RALPH EDWARD PENDERGRAPH II

MEDICARE:  MR. RALPH EDWARD PENDERGRAPH II
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical SuppliesFL

General Provider Information

NPI Number : 1851505481
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RALPH EDWARD PENDERGRAPH II
Provider Business Mailing Address
First Line : 5230 N ORANGE BLOSSOM TRL
Second Line : #306
City : ORLANDO
State : FL
Zip : 32810-4769
Country : US
Telephone Number : 407-926-5006
Fax Number :
Provider Business Practice Location Address
First Line : 5230 N ORANGE BLOSSOM TRL
Second Line : #306
City : ORLANDO
State : FL
Zip : 32810-4769
Country : US
Telephone Number : 407-926-5006
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2007
Last Update Date : 07/08/2007

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Directions to “ MR. RALPH EDWARD PENDERGRAPH II ” Practice Location

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