Provider Demographics
NPI:1902063183
Name:RALPH B RABIN DPM LLC
Entity Type:Organization
Organization Name:RALPH B RABIN DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:RABIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:623-846-9000
Mailing Address - Street 1:4550 N 51ST AVE
Mailing Address - Street 2:SUITE 31
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1708
Mailing Address - Country:US
Mailing Address - Phone:623-846-9000
Mailing Address - Fax:623-846-4021
Practice Address - Street 1:14044 W CAMELBACK RD
Practice Address - Street 2:SUITE 114
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9428
Practice Address - Country:US
Practice Address - Phone:623-846-9000
Practice Address - Fax:623-846-4021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RALPH B RABIN DPM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ612151800OtherFEDERAL WORKERSCOMP
AZ612151800OtherFEDERAL WORKERSCOMP