Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 2004-00578 | NC |
NPI | 1275538449 |
---|---|
Provider Name | Dr. Jeffrey John Ralston |
First Address | Charlotte, NC 28222-1249 |
Second Address | Charlotte, NC 28211-2117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 13/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1275538449 | (05) | NC |
89137J0 | (05) | NC |
I10756 | (02) | NC |