Provider Demographics
NPI:1710048079
Name:RAUGUST, RICHARD P (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:RAUGUST
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 1:1919 LATHROP ST.
Mailing Address - Street 2:STE 103
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5937
Mailing Address - Country:US
Mailing Address - Phone:907-456-7768
Mailing Address - Fax:907-456-4045
Practice Address - Street 1:1919 LATHROP ST.
Practice Address - Street 2:STE 103
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5937
Practice Address - Country:US
Practice Address - Phone:907-456-7768
Practice Address - Fax:907-456-4045
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1262207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK040005331OtherMEDICARE RR
AKMD1262Medicaid
AKK04WCKDJBMedicare PIN
AKMD1262Medicaid