Healthcare Provider Details

I. General information

NPI: 1669759122
Provider Name (Legal Business Name): ROBERT RACELIS DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2011
Last Update Date: 11/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HUGHES RD STE E
MADISON AL
35758-3000
US

IV. Provider business mailing address

34 HUGHES RD STE E
MADISON AL
35758-3000
US

V. Phone/Fax

Practice location:
  • Phone: 256-464-5030
  • Fax: 256-464-5034
Mailing address:
  • Phone: 256-464-5030
  • Fax: 256-464-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number5837
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: