Provider Demographics
NPI:1578807442
Name:UY, RAFAELANI TARUC (MD)
Entity Type:Individual
Prefix:
First Name:RAFAELANI
Middle Name:TARUC
Last Name:UY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1718 E KESSLER BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-1842
Mailing Address - Country:US
Mailing Address - Phone:360-747-5849
Mailing Address - Fax:360-575-3846
Practice Address - Street 1:1718 E KESSLER BLVD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-1842
Practice Address - Country:US
Practice Address - Phone:360-747-5849
Practice Address - Fax:360-575-3846
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125059208207Q00000X
WAMD60439195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine