Healthcare Provider Details

I. General information

NPI: 1336526052
Provider Name (Legal Business Name): RAUL ALEXANDER CABOS PERALTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 W 6TH ST STE 100
LAWRENCE KS
66049-7700
US

IV. Provider business mailing address

5301 FARAON ST STE 120
SAINT JOSEPH MO
64506
US

V. Phone/Fax

Practice location:
  • Phone: 785-505-5160
  • Fax: 785-505-5282
Mailing address:
  • Phone: 816-271-7979
  • Fax: 816-271-7971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2023018866
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number0442769
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: