Provider Demographics
NPI:1245390756
Name:RAUSCH, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RAUSCH
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 1:2701 MALL DR
Mailing Address - Street 2:SUITE #9
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-7502
Mailing Address - Country:US
Mailing Address - Phone:256-768-1005
Mailing Address - Fax:256-768-0209
Practice Address - Street 1:2701 MALL DR
Practice Address - Street 2:SUITE #9
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-7502
Practice Address - Country:US
Practice Address - Phone:256-768-1005
Practice Address - Fax:256-768-0209
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL62702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3132269OtherBLUE CROSS BLUE SHIELD TN
ALRAILROAD MEDICAREOther300098220
AL16-10450OtherUNITED HEALTHCARE
AL000045171Medicaid
AL051045171OtherBLUE CROSS BLUE SHIELD AL
AL16-10450OtherUNITED HEALTHCARE
ALC76258Medicare UPIN