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General NPI Number Information
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NPI Number | 1750444907
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Entity Type | Individual
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Provider Name | NATHAN RANALLI MD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 836 PRUDENTIAL DR SUITE 1205
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8334
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Country | US
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Telephone | 904-633-0780
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Fax | 904-633-0783
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Provider Business Mailing Address
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Address Line | PO BOX 44008 PROVIDER ENROLLMENT
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City | JACKSONVILLE
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State | FL
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Zip | 32231-4008
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Country | US
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Telephone | 904-244-3660
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Fax | 904-244-3425
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | MD429742
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 2011006604
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | ME112245
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License Number State | FL
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