Provider Demographics
NPI:1922002864
Name:RAKESTRAW, JOSEPH CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CHARLES
Last Name:RAKESTRAW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-3279
Mailing Address - Country:US
Mailing Address - Phone:573-635-2211
Mailing Address - Fax:573-636-9350
Practice Address - Street 1:606 E HIGH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3279
Practice Address - Country:US
Practice Address - Phone:573-635-2211
Practice Address - Fax:573-636-9350
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO248012114Medicaid
MO248012122Medicaid
MO248012114Medicaid
MO000004475Medicare ID - Type Unspecified
MO000004473Medicare ID - Type Unspecified