Provider Demographics
NPI:1689766719
Name:RAUCHER, SANJA (MD)
Entity Type:Individual
Prefix:
First Name:SANJA
Middle Name:
Last Name:RAUCHER
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 1:2500 NORTH STATE STREET
Mailing Address - Street 2:JMM ROOM 2525
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-6426
Mailing Address - Fax:601-984-6439
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-1196
Practice Address - Fax:601-984-5939
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18731207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00282995OtherRAILROAD MEDICARE
MS08234897Medicaid
MSP00462312OtherRAILROAD MEDICARE
MS512I050003Medicare PIN
MSP00462312OtherRAILROAD MEDICARE
I34432Medicare UPIN
MSP00282995OtherRAILROAD MEDICARE