=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477500494
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAE E RINGENBERG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2006
-----------------------------------------------------
Last Update Date | 08/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 N PARK AVE SUITE 101
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-4101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-886-1300
-----------------------------------------------------
Fax | 407-886-1305
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 N PARK AVE SUITE 101
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-4101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-886-1300
-----------------------------------------------------
Fax | 407-886-1305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME77976
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------