Individual
NATHAN RANALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
836 PRUDENTIAL DR, SUITE 1205, JACKSONVILLE, FL 32207-8334
(904) 633-0780
(904) 633-0783
Mailing address
PO BOX 44008, PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
(904) 244-3660
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
2011006604
MO
207T00000X
Neurological Surgery Physician
MD429742
PA
207T00000X
Neurological Surgery Physician
Primary
ME112245
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003124430A
—
GA
05
—
005789500
—
FL
01
—
14K65
BCBS
FL
Enumeration date
12/19/2006
Last updated
07/31/2012
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