Provider Demographics
NPI:1447430608
Name:SAINT RAPHAEL FAMILY FOCUSED MEDICINE PA
Entity Type:Organization
Organization Name:SAINT RAPHAEL FAMILY FOCUSED MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MANNING
Authorized Official - Last Name:LACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-383-6861
Mailing Address - Street 1:10350 BANDERA RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-5615
Mailing Address - Country:US
Mailing Address - Phone:210-383-6861
Mailing Address - Fax:
Practice Address - Street 1:10350 BANDERA RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-5615
Practice Address - Country:US
Practice Address - Phone:210-383-6861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00375YMedicare Oscar/Certification