Provider Demographics
NPI:1316040801
Name:EMMOTT, RALPH CAMERON (MD)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:CAMERON
Last Name:EMMOTT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1720 EL CAMINO REAL
Mailing Address - Street 2:#210
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3226
Mailing Address - Country:US
Mailing Address - Phone:650-697-3434
Mailing Address - Fax:650-697-1629
Practice Address - Street 1:1720 EL CAMINO REAL
Practice Address - Street 2:#210
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3226
Practice Address - Country:US
Practice Address - Phone:650-697-3434
Practice Address - Fax:650-697-1629
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2015-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA26174208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A261740Medicaid
CA00A261740Medicaid
A24758Medicare UPIN