Provider Demographics
NPI:1750815445
Name:FRATKIN, RAPHAEL PAUL (LAC, MSAC)
Entity Type:Individual
Prefix:MR
First Name:RAPHAEL
Middle Name:PAUL
Last Name:FRATKIN
Suffix:
Gender:M
Credentials:LAC, MSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7764 JADE CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-3225
Mailing Address - Country:US
Mailing Address - Phone:303-819-6401
Mailing Address - Fax:
Practice Address - Street 1:7764 JADE CT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-3225
Practice Address - Country:US
Practice Address - Phone:303-819-6401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002283171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist