Healthcare Provider Details

I. General information

NPI: 1073578654
Provider Name (Legal Business Name): RALPH ZIPPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 S HARBOR CITY BLVD SUITE 101
MELBOURNE FL
32901-1966
US

IV. Provider business mailing address

1130 S HARBOR CITY BLVD SUITE 101
MELBOURNE FL
32901-1966
US

V. Phone/Fax

Practice location:
  • Phone: 321-914-4211
  • Fax: 321-914-4212
Mailing address:
  • Phone: 321-914-4211
  • Fax: 321-914-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME76190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: