Provider Demographics
NPI:1073213732
Name:RAUCH, RALPH JEROME (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:JEROME
Last Name:RAUCH
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 1:3561 OCONNER DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4932
Mailing Address - Country:US
Mailing Address - Phone:925-283-3058
Mailing Address - Fax:
Practice Address - Street 1:3561 OCONNER DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4932
Practice Address - Country:US
Practice Address - Phone:925-283-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG172862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty