Provider Demographics
NPI:1053483107
Name:PENDLETON, RALPH LLEWELLYN (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:LLEWELLYN
Last Name:PENDLETON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10509 MILL STATION RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-9657
Mailing Address - Country:US
Mailing Address - Phone:707-823-9065
Mailing Address - Fax:707-829-6932
Practice Address - Street 1:10509 MILL STATION RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-9657
Practice Address - Country:US
Practice Address - Phone:707-823-9065
Practice Address - Fax:707-829-6932
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA18429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine