Healthcare Provider Details

I. General information

NPI: 1063450773
Provider Name (Legal Business Name): RALPH ZAGHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 NW 49TH AVE SUITE 207
LAUDERDALE LAKES FL
33313-1600
US

IV. Provider business mailing address

2951 NW 49TH AVE SUITE 207
LAUDERDALE LAKES FL
33313-1600
US

V. Phone/Fax

Practice location:
  • Phone: 954-652-0246
  • Fax: 954-652-0471
Mailing address:
  • Phone: 954-652-0246
  • Fax: 954-652-0471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME95299
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number215117
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: