MEDICARE: RC RALEY PROFESSIONAL ASSOCIATION

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	364SA2200X	Adult Health Clinical Nurse Specialist
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1407168552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RC RALEY PROFESSIONAL ASSOCIATION

Provider Business Mailing Address
First Line	:	807 STARK ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-1508
Country	:	US
Telephone Number	:	512-452-2506
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 W NORTH LOOP BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-2326
Country	:	US
Telephone Number	:	512-452-2506
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT C RALEY
Credential	:	M.D.
Telephone Number	:	512-452-2506

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	04/03/2024

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