Provider Demographics
NPI:1427082627
Name:FOSSETT, RALPH THOMAS (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:THOMAS
Last Name:FOSSETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1077
Mailing Address - Country:US
Mailing Address - Phone:606-784-1049
Mailing Address - Fax:606-784-2542
Practice Address - Street 1:425 CLINIC DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1077
Practice Address - Country:US
Practice Address - Phone:606-784-7551
Practice Address - Fax:606-780-2373
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14451207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64144512Medicaid
KY0940108Medicare PIN
KY64144512Medicaid