Provider Demographics
NPI:1487676573
Name:RALEIGH, TIMOTHY B (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:B
Last Name:RALEIGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2305 SOUTH 65 HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3702
Mailing Address - Country:US
Mailing Address - Phone:660-886-7431
Mailing Address - Fax:660-886-9001
Practice Address - Street 1:2305 SOUTH 65 HIGHWAY
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3702
Practice Address - Country:US
Practice Address - Phone:660-886-7431
Practice Address - Fax:660-886-9001
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO112876207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1487373573Medicaid
MOE75000012Medicare Oscar/Certification
MOG21091Medicare UPIN
MO115050069Medicare ID - Type Unspecified