MEDICARE: JANNA RAE RAPHELSON

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	207RP1001X	Pulmonary Disease Physician	W3602	TX
2	207R00000X	Internal Medicine Physician	W3602	TX
3	208M00000X	Hospitalist Physician	A177298	CA
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	W3602	TX
5	207RP1001X	Pulmonary Disease Physician	A177298	CA

General Provider Information

NPI Number	:	1770042699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANNA RAE RAPHELSON

Provider Business Mailing Address
First Line	:	6411 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	269-716-4305
Fax Number	:

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	06/08/2026

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Directions to “ JANNA RAE RAPHELSON ” Practice Location

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