Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A24305 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | A24305 | CA |
N | 207QA0505X | Family Doctor - Adult Medicine | A24305 | CA |
N | 208D00000X | General Practice Physician | A24305 | CA |
NPI | 1801043799 |
---|---|
Provider Name | Dr. Ralph Edward Retherford |
First Address | Sonora, CA 95370-1990 |
Second Address | Sonora, CA 95370-8780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2008 |
Last Update Date | 18/08/2016 |