Provider Demographics
NPI:1861501579
Name:TORRENCE, RALPH J (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:J
Last Name:TORRENCE
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 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8242
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-8200
Mailing Address - Fax:314-454-5244
Practice Address - Street 1:4921 PARKVIEW PL STE 11C
Practice Address - Street 2:STE 11C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-8200
Practice Address - Fax:314-454-5244
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6B19208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1861501579Medicaid
ILENROLLEDMedicaid