MEDICARE: MR. RALPH EDWARD PENDERGRAPH II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		FL

General Provider Information

NPI Number	:	1851505481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RALPH EDWARD PENDERGRAPH II

Provider Business Mailing Address
First Line	:	5230 N ORANGE BLOSSOM TRL
Second Line	:	#306
City	:	ORLANDO
State	:	FL
Zip	:	32810-4769
Country	:	US
Telephone Number	:	407-926-5006
Fax Number	:

Provider Business Practice Location Address
First Line	:	5230 N ORANGE BLOSSOM TRL
Second Line	:	#306
City	:	ORLANDO
State	:	FL
Zip	:	32810-4769
Country	:	US
Telephone Number	:	407-926-5006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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