Healthcare Provider Details

I. General information

NPI: 1588951982
Provider Name (Legal Business Name): RALPH RYBACK MD LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 TAMIAMI TRL N SUITE 330
NAPLES FL
34103-4409
US

IV. Provider business mailing address

2614 TAMIAMI TRAIL NORTH SUITE 330
NAPLES FL
34103
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-5075
  • Fax: 352-597-9900
Mailing address:
  • Phone: 352-597-5075
  • Fax: 352-597-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberME92563
License Number StateFL

VIII. Authorized Official

Name: RALPH S RYBACK
Title or Position: PRESIDENT
Credential: MD
Phone: 352-597-5075