Provider Demographics
NPI:1063432953
Name:RALSTON, DEBORAH H (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:H
Last Name:RALSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-4407
Mailing Address - Country:US
Mailing Address - Phone:319-874-3000
Mailing Address - Fax:319-874-3411
Practice Address - Street 1:6007 33RD AVENUE DR
Practice Address - Street 2:
Practice Address - City:SHELLSBURG
Practice Address - State:IA
Practice Address - Zip Code:52332-9569
Practice Address - Country:US
Practice Address - Phone:920-716-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0076372Medicaid
WI34010900Medicaid