Spafford, Ralph Douglas
Spafford, Ralph Douglas is an individual health care provider with primary practice located at 916 Talon Dr Suite 102, O Fallon IL 62269-1848. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Spafford, Ralph Douglas can be contacted via phone (618) 628-8211.Contact Information
Primary practice address
916 Talon Dr Suite 102
O Fallon IL 62269-1848
Phone: (618) 628-8211
Fax: (618) 628-0883
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 117199 | Missouri |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 385000318 | Illinois |
Profile Details
| NPI number | 1043446008 |
|---|---|
| LBN Legal business name | Spafford, Ralph Douglas |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 4th, 2009 |
| Last updated | Mar 14th, 2012 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043446008 | NPPES |
| Illinois | Other | 1811940893 | TRICARE |
| Illinois | Other | 1811940893 | TRICARE |
| Illinois | Other | 1811940893 | TRICARE |
| Illinois | Other | 1811940893 | TRICARE |
| Illinois | Other | 1811940893 | TRICARE |
| Illinois | Other | 1811940893 | TRICARE |
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