Individual
DR. JEFFREY JOHN RALSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3623 LATROBE DR STE 216, CHARLOTTE, NC 28211-2117
(704) 332-1291
(704) 926-1832
Mailing address
PO BOX 221249, CHARLOTTE, NC 28222-1249
(704) 332-1291
(704) 332-5206
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
2004-00578
NC
2085R0202X
Diagnostic Radiology Physician
Primary
200400578
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275538449
—
NC
05
—
89137J0
—
NC
Enumeration date
06/15/2005
Last updated
09/13/2020
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