Healthcare Provider Details

I. General information

NPI: 1568751790
Provider Name (Legal Business Name): RAUL A RAUDALES JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 N LA CHOLLA BLVD STE 200
TUCSON AZ
85741-3549
US

IV. Provider business mailing address

PO BOX 31630
TUCSON AZ
85751-1630
US

V. Phone/Fax

Practice location:
  • Phone: 520-382-8200
  • Fax: 520-297-3505
Mailing address:
  • Phone: 520-784-6200
  • Fax: 520-784-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35.124202
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number74060
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: