Provider Demographics
NPI:1952319816
Name:RALPH E RETHERFORD MD INC
Entity Type:Organization
Organization Name:RALPH E RETHERFORD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:RETHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-588-1424
Mailing Address - Street 1:16050 VIA ESTE RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370
Mailing Address - Country:US
Mailing Address - Phone:209-588-1424
Mailing Address - Fax:209-588-1521
Practice Address - Street 1:16050 VIA ESTE RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-8428
Practice Address - Country:US
Practice Address - Phone:209-588-1424
Practice Address - Fax:209-588-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A243050Medicare ID - Type Unspecified
F15359Medicare UPIN