Provider Demographics
NPI:1679652218
Name:GROVES, RALPH JAMES (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:JAMES
Last Name:GROVES
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 1:801 VASSAR DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2725
Mailing Address - Country:US
Mailing Address - Phone:505-248-4065
Mailing Address - Fax:505-248-4093
Practice Address - Street 1:9000 AHWAHNEE DRIVE
Practice Address - Street 2:YOSEMITE MEDICAL CLINIC
Practice Address - City:YOSEMITE
Practice Address - State:CA
Practice Address - Zip Code:95389
Practice Address - Country:US
Practice Address - Phone:209-372-4637
Practice Address - Fax:209-372-4330
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0334207Q00000X
RIMD10834207Q00000X
CAC54835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ866733Medicaid
NM37670889Medicaid
NM37670889Medicaid