Provider Demographics
NPI:1063493690
Name:RAULERSON, MARSHA D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:D
Last Name:RAULERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 BELLEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-1304
Mailing Address - Country:US
Mailing Address - Phone:251-867-3608
Mailing Address - Fax:251-867-3610
Practice Address - Street 1:1205 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1304
Practice Address - Country:US
Practice Address - Phone:251-867-3608
Practice Address - Fax:251-867-3610
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4469208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL541393901Medicaid
FL911084400Medicaid
AL51009768OtherBC/BS OF ALABAMA
AL000009768Medicaid
FL911084400Medicaid