Healthcare Provider Details

I. General information

NPI: 1588860381
Provider Name (Legal Business Name): STEPHANIE JEANNE RAEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10511 GOLF COURSE RD NW
ALBUQUERQUE NM
87114-5916
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-7281
  • Fax: 505-262-7622
Mailing address:
  • Phone: 505-262-7915
  • Fax: 505-232-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberRS2007-0352
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2012-0648
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: