Provider Demographics
NPI:1699856187
Name:SMATHERS, RALPH L (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:L
Last Name:SMATHERS
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 1:14651 S BASCOM AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2014
Mailing Address - Country:US
Mailing Address - Phone:408-356-6611
Mailing Address - Fax:408-356-9001
Practice Address - Street 1:14651 S BASCOM AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2014
Practice Address - Country:US
Practice Address - Phone:408-356-6611
Practice Address - Fax:408-356-9001
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49899174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G498990Medicare ID - Type UnspecifiedMEDICARE ID NUMBER