Provider Demographics
NPI:1114999034
Name:RAPER, KENNETH S (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:S
Last Name:RAPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7475 MCLAUGHLIN RD
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4716
Mailing Address - Country:US
Mailing Address - Phone:719-495-9994
Mailing Address - Fax:719-495-9904
Practice Address - Street 1:7475 MCLAUGHLIN RD
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-4716
Practice Address - Country:US
Practice Address - Phone:719-495-9994
Practice Address - Fax:719-495-9904
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01332923Medicaid
CO01332923Medicaid
COE74796Medicare UPIN