Provider Demographics
NPI:1518128867
Name:RALEY, RICHARD ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:RALEY
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 1:638 DONNER AVE
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-7132
Mailing Address - Country:US
Mailing Address - Phone:707-938-7076
Mailing Address - Fax:707-938-7086
Practice Address - Street 1:638 DONNER AVE
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-7132
Practice Address - Country:US
Practice Address - Phone:707-938-7076
Practice Address - Fax:707-938-7086
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2010-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40688207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology