Ralph E Ballentine, MD
Individual provider Active NPI Psychiatry Physician · Fern Park, FL
NPI 1124154943 · NPPES record last updated Apr 7, 2011
Key facts
- NPI
- 1124154943
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- ME17742 (FL)
- Practice address
- 237 Fernwood Blvd
Fern Park, FL 32730-2116 - Phone
- (407) 831-2411
- Fax
- (407) 831-0195
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | ME17742 | FL | Yes |
Addresses
Primary practice location
237 Fernwood Blvd
Fern Park, FL 32730-2116
Mailing address
1840 Lake Emma Rd
Longwood, FL 32750-7137
Phone (321) 695-0157
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 280555300 | Medicaid | FL |
Other providers in Fern Park, FL
- Stacie Aldrich
- Amaya Papaya L.L.C.
- Patrice Shondelle Anderson
- Justin Alexander Arroyo
- Jeffry Antonio Barquero Salazar
- James Bartlett
- Cheryl A Bosselman
- Brent H Weinman
- Derdine Noel Brown
All providers in Fern Park, FL · Psychiatry Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.