Provider Demographics
NPI:1902121544
Name:LING, TED (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:LING
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:77840 FLORA RD
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-4109
Practice Address - Country:US
Practice Address - Phone:760-200-8777
Practice Address - Fax:760-200-8877
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1179542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA815594Medicaid
CA1902121544Medicaid
CA6398643OtherCIGNA
FLP01732533OtherRR MEDICARE
CA6398643OtherCIGNA
FLP01732533OtherRR MEDICARE
CACA217011Medicare PIN