Provider Demographics
NPI:1336114800
Name:GORRELL, RACHELLE L (DO)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:L
Last Name:GORRELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2905
Mailing Address - Country:US
Mailing Address - Phone:573-364-9000
Mailing Address - Fax:
Practice Address - Street 1:1000 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559
Practice Address - Country:US
Practice Address - Phone:573-265-8840
Practice Address - Fax:573-202-2474
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001007763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO002013368OtherFFS MEDICARE/WPS
MO263904OtherRURAL HEALTH MEDICARE
MO431908560OtherTRIWEST
MO464413OtherHEALTHLINK
MO245323704Medicaid
MO431908560OtherPHCS
MO596841403Medicaid
MO0101983OtherUNITED HEALTH CARE
MO080174605OtherRAILROAD MEDICARE
MO144176OtherBLUE SHIELD OF MO