Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0131X | Foot Surgery | 121 | AL |
Y | 213ES0131X | Foot Surgery | PO-1815 | FL |
NPI | 1114135977 |
---|---|
Provider Name | Dr. John Greel Ralls JR. |
First Address | Pensacola, FL 32503-6329 |
Second Address | Pensacola, FL 32503-6329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T90786 | (02) |