MEDICARE: TAL R RAPHAELI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	P1919	TX

General Provider Information

NPI Number	:	1609910009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAL R RAPHAELI MD

Provider Business Mailing Address
First Line	:	1125 CYPRESS STATION DR STE G-3
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3055
Country	:	US
Telephone Number	:	281-583-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 CYPRESS STATION DR STE G-3
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3055
Country	:	US
Telephone Number	:	281-583-1300
Fax Number	:	281-583-1303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2007
Last Update Date	:	02/27/2023

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