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:
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Health care specialties

SpecialtyCodeLicense #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 12 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.

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Identifiers

StateTypeNumberIssuer
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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