Provider Demographics
NPI:1154639417
Name:RALPH BRESLAW MD PA
Entity type:Organization
Organization Name:RALPH BRESLAW MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESLAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-272-1234
Mailing Address - Street 1:229 GEORGE BUSH BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-4034
Mailing Address - Country:US
Mailing Address - Phone:561-272-1234
Mailing Address - Fax:561-274-2060
Practice Address - Street 1:229 GEORGE BUSH BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-4034
Practice Address - Country:US
Practice Address - Phone:561-272-1234
Practice Address - Fax:561-274-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300426100Medicaid
FL300426100Medicaid