Healthcare Provider Details

I. General information

NPI: 1386612653
Provider Name (Legal Business Name): JEFFREY B RAPP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMUNITY MEMORIAL HOSPITAL 512 SKYLINE BLVD
CLOQUET MN
55720-1199
US

IV. Provider business mailing address

COMMUNITY MEMORIAL HOSPITAL 512 SKYLINE BLVD
CLOQUET MN
55720-1199
US

V. Phone/Fax

Practice location:
  • Phone: 218-879-4641
  • Fax: 218-927-4130
Mailing address:
  • Phone: 218-879-4641
  • Fax: 218-927-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number42724
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: