Individual
PHILIP MARK RALIDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
601 E 15TH ST, AUSTIN, TX 78701-1930
(512) 324-7000
Mailing address
3003 LOVELAND CV, AUSTIN, TX 78746-7635
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
J7147
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123643205
—
TX
Enumeration date
04/18/2006
Last updated
07/08/2007
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