Healthcare Provider Details

I. General information

NPI: 1356528210
Provider Name (Legal Business Name): RAULERSON GYN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 HIGHWAY 441 NORTH SUITE F
OKEECHOBEE FL
34972
US

IV. Provider business mailing address

THREE MARYLAND SUITE 250
BRENTWOOD TN
37027
US

V. Phone/Fax

Practice location:
  • Phone: 863-763-8000
  • Fax: 863-763-8212
Mailing address:
  • Phone: 615-372-5024
  • Fax: 866-899-5924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES BRADFIELD
Title or Position: AUTHORIZE OFFICIAL
Credential:
Phone: 863-763-8000