Healthcare Provider Details

I. General information

NPI: 1508980186
Provider Name (Legal Business Name): JESUS RAPHAEL RANGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 RIVER DR
PIKEVILLE KY
41501-1685
US

IV. Provider business mailing address

197 E CEDAR DR
PIKEVILLE KY
41501-2019
US

V. Phone/Fax

Practice location:
  • Phone: 606-437-5500
  • Fax: 606-437-0873
Mailing address:
  • Phone: 606-437-5500
  • Fax: 606-437-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32202
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number32202
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: