Healthcare Provider Details

I. General information

NPI: 1073729240
Provider Name (Legal Business Name): RALPH ZIPPER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S HARBOR CITY BLVD STE 401
MELBOURNE FL
32901-1389
US

IV. Provider business mailing address

200 S HARBOR CITY BLVD STE 401
MELBOURNE FL
32901-1389
US

V. Phone/Fax

Practice location:
  • Phone: 321-674-2114
  • Fax: 321-674-2118
Mailing address:
  • Phone: 321-674-2114
  • Fax: 321-674-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME76190
License Number StateFL

VIII. Authorized Official

Name: DR. RALPH ZIPPER
Title or Position: PRESIDENT
Credential: M.D
Phone: 321-674-2114