Healthcare Provider Details

I. General information

NPI: 1063493690
Provider Name (Legal Business Name): MARSHA D. RAULERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 BELLEVILLE AVE
BREWTON AL
36426-1304
US

IV. Provider business mailing address

1205 BELLEVILLE AVE
BREWTON AL
36426-1304
US

V. Phone/Fax

Practice location:
  • Phone: 251-867-3608
  • Fax: 251-867-3610
Mailing address:
  • Phone: 251-867-3608
  • Fax: 251-867-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4469
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: