Healthcare Provider Details

I. General information

NPI: 1073610606
Provider Name (Legal Business Name): STEPHEN M. RAFFLE, M.D. & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 WOLFE GRADE
KENTFIELD CA
94904-1011
US

IV. Provider business mailing address

35 WOLFE GRADE
KENTFIELD CA
94904-1011
US

V. Phone/Fax

Practice location:
  • Phone: 415-461-4845
  • Fax: 415-461-4039
Mailing address:
  • Phone: 415-461-4845
  • Fax: 415-461-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG16478
License Number StateCA

VIII. Authorized Official

Name: DR. STEPHEN MERRIT RAFFLE
Title or Position: FORENSIC PSYCHIATRIST
Credential: M.D.
Phone: 415-461-4845