Healthcare Provider Details

I. General information

NPI: 1598717662
Provider Name (Legal Business Name): JEFFREY S RASCH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOBCAT CIRCLE MSU CLINIC
BOZEMAN MT
59717
US

IV. Provider business mailing address

915 HIGHLAND BLVD
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-4780
  • Fax:
Mailing address:
  • Phone: 406-414-1826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number57672501204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number59970
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number11792
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: