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NPI Code Detail

MEDICARE: DR. THEODORE W RASOUMOFF M.D.

MEDICARE:  DR. THEODORE W RASOUMOFF  M.D.
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
1207L00000XAnesthesiology PhysicianG83538CA

General Provider Information

NPI Number : 1285628081
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THEODORE W RASOUMOFF M.D.
Provider Business Mailing Address
First Line : 150 PIONEER LN
Second Line :
City : BISHOP
State : CA
Zip : 93514-2556
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 150 PIONEER LN
Second Line :
City : BISHOP
State : CA
Zip : 93514-2556
Country : US
Telephone Number : 760-873-5811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2005
Last Update Date : 10/29/2024

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Directions to “ DR. THEODORE W RASOUMOFF M.D.” Practice Location

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