Provider Demographics
NPI:1598717662
Name:RASCH, JEFFREY S (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:RASCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6902
Mailing Address - Country:US
Mailing Address - Phone:406-414-1826
Mailing Address - Fax:
Practice Address - Street 1:1 BOBCAT CIRCLE
Practice Address - Street 2:MSU CLINIC
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59717
Practice Address - Country:US
Practice Address - Phone:406-414-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN59970207QS0010X
MT11792207RS0010X
UT57672501204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT807165900Medicaid
UT903343OtherDMBA GRP 22
UTQM0000025083OtherALTIUS GRP 22
UT100506339Medicaid
UT84422OtherPEHP GRP 22
MT0000093458OtherBCBS OF MONTANA
UT121126900Medicaid
UT57672501200001OtherBCBS GRP 22
UTD6127Medicaid
UT0143327Medicaid
UT90080OtherU HEALTH PLANS GRP22
UT84422OtherPEHP GRP 22
UT121126900Medicaid