Healthcare Provider Details

I. General information

NPI: 1316924707
Provider Name (Legal Business Name): COREY RAFFEL M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF NEUROLOGICAL SURGERY M780 505 PARNASSUS AVE.
SAN FRANCISCO CA
94143-0001
US

IV. Provider business mailing address

DEPARTMENT OF NEUROLOGICAL SURGERY M780 505 PARNASSUS AVE.
SAN FRANCISCO CA
94143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-3489
  • Fax: 415-353-3907
Mailing address:
  • Phone: 415-353-3489
  • Fax: 415-353-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberG46212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: