MEDICARE: JESSE RAEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	G89384	CA
2	2085N0700X	Neuroradiology Physician	86312	NM
3	2085R0202X	Diagnostic Radiology Physician	86312	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265455505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE RAEL MD

Provider Business Mailing Address
First Line	:	4901 LANG AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109
Country	:	US
Telephone Number	:	505-842-8171
Fax Number	:	505-246-0684

Provider Business Practice Location Address
First Line	:	3883 AIRWAY DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1670
Country	:	US
Telephone Number	:	707-521-4480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	09/04/2025

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