Provider Demographics
NPI:1962535617
Name:WURSTER, RALPH MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:MICHAEL
Last Name:WURSTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5730 SHERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-5642
Mailing Address - Country:US
Mailing Address - Phone:325-944-3851
Mailing Address - Fax:325-947-1626
Practice Address - Street 1:5730 SHERWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-5642
Practice Address - Country:US
Practice Address - Phone:325-944-3851
Practice Address - Fax:325-947-1626
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9894207Q00000X
FL0S6853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-2974863OtherTAX ID
FL379175100Medicaid
FL379175100Medicaid
FL379175100Medicaid
FL57199BMedicare PIN