Provider Demographics
NPI:1619056959
Name:JAATOUL, RAQUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:
Last Name:JAATOUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9706 S BLUFFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4035
Mailing Address - Country:US
Mailing Address - Phone:180-141-4171
Mailing Address - Fax:
Practice Address - Street 1:400 SOLDIER CREEK ROAD PHS ROSEBUD
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-0400
Practice Address - Country:US
Practice Address - Phone:605-747-2231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5866368-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine