Provider Demographics
NPI:1770669053
Name:YOUNG-RODRIGUEZ, RAUL NEFTALI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:NEFTALI
Last Name:YOUNG-RODRIGUEZ
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:PO BOX 15805
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-0805
Mailing Address - Country:US
Mailing Address - Phone:206-417-3284
Mailing Address - Fax:
Practice Address - Street 1:1060 GAFFNEY RD # 7440
Practice Address - Street 2:MCUC-QMD-CP CREDENTIALS BASSETT ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-5001
Practice Address - Country:US
Practice Address - Phone:907-353-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020486207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine