Provider Demographics
NPI:1801043799
Name:RETHERFORD, RALPH EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:EDWARD
Last Name:RETHERFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4990
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-1990
Mailing Address - Country:US
Mailing Address - Phone:209-588-1424
Mailing Address - Fax:209-588-1521
Practice Address - Street 1:20405 LYONS BALD MTN RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-8780
Practice Address - Country:US
Practice Address - Phone:209-588-1424
Practice Address - Fax:209-588-1521
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24305207Q00000X, 207QA0000X, 207QA0401X, 207QA0505X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice