Provider Demographics
NPI:1609910009
Name:RAPHAELI, TAL R (MD)
Entity Type:Individual
Prefix:
First Name:TAL
Middle Name:R
Last Name:RAPHAELI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 CYPRESS STATION DR STE G-3
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3055
Mailing Address - Country:US
Mailing Address - Phone:281-583-1300
Mailing Address - Fax:
Practice Address - Street 1:1125 CYPRESS STATION DR STE G-3
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3055
Practice Address - Country:US
Practice Address - Phone:281-583-1300
Practice Address - Fax:281-583-1303
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1919208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery