Provider Demographics
NPI:1073602173
Name:RAULERSON & RAULERSON PHYSICIANS
Entity Type:Organization
Organization Name:RAULERSON & RAULERSON PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAULERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-867-3606
Mailing Address - Street 1:1205 BELLEVILLE AVE.
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426
Mailing Address - Country:US
Mailing Address - Phone:251-867-3606
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:251-867-3606
Practice Address - Fax:251-867-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51009768OtherBC/BS OF AL
AL51511894OtherBC/BS OFAL
AL891003040Medicaid
AL51022662OtherBC/BS AL AL
AL51524734OtherBC/BS OF AL
AL009969685Medicaid
AL000022662Medicaid
AL000009768Medicaid
AL22662Medicare ID - Type Unspecified
AL009969685Medicaid
AL51511894OtherBC/BS OFAL
AL51524734OtherBC/BS OF AL
AL78317Medicare UPIN
AL000009768Medicaid