Healthcare Provider Details

I. General information

NPI: 1114224292
Provider Name (Legal Business Name): RALPH S RYBACK MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 PANTHER LN STE 248
NAPLES FL
34109-7874
US

IV. Provider business mailing address

13406 CORTEZ BLVD
BROOKSVILLE FL
34613
US

V. Phone/Fax

Practice location:
  • Phone: 239-213-0012
  • Fax:
Mailing address:
  • Phone: 352-597-5075
  • Fax: 352-597-9644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberME92563
License Number StateFL

VIII. Authorized Official

Name: DR. RALPH S RYBACK
Title or Position: OWNER
Credential: MD
Phone: 239-213-0012