Provider Demographics
NPI:1538385752
Name:EVERETT, RALPH E (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:E
Last Name:EVERETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 S CASCADE AVE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1675
Mailing Address - Country:US
Mailing Address - Phone:719-577-9042
Mailing Address - Fax:719-475-7175
Practice Address - Street 1:90 S CASCADE AVE
Practice Address - Street 2:SUITE 810
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1675
Practice Address - Country:US
Practice Address - Phone:719-577-9042
Practice Address - Fax:719-475-7175
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO268342084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COB74317Medicare UPIN