Provider Demographics
NPI:1033105887
Name:RAKO, JULES (MD)
Entity Type:Individual
Prefix:MR
First Name:JULES
Middle Name:
Last Name:RAKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 OAK ST
Mailing Address - Street 2:STE 200W
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1168
Mailing Address - Country:US
Mailing Address - Phone:508-586-7334
Mailing Address - Fax:508-583-7599
Practice Address - Street 1:830 OAK ST
Practice Address - Street 2:STE 200W
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1168
Practice Address - Country:US
Practice Address - Phone:508-586-7334
Practice Address - Fax:508-583-7599
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA28643208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0171328Medicaid
B10099301OtherCIGNA
C16038OtherBLUE CROSS
21234OtherBMC HEALTHNET
20013OtherHPHC
28870OtherFALLON
92110OtherAETNA
028643OtherTUFTS
C16038OtherBLUE CROSS