Provider Demographics
NPI:1356528210
Name:RAULERSON GYN LLC
Entity type:Organization
Organization Name:RAULERSON GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZE OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-763-8000
Mailing Address - Street 1:THREE MARYLAND
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-372-5024
Mailing Address - Fax:866-899-5924
Practice Address - Street 1:1713 HIGHWAY 441 NORTH
Practice Address - Street 2:SUITE F
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972
Practice Address - Country:US
Practice Address - Phone:863-763-8000
Practice Address - Fax:863-763-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000640400Medicaid
FLAL354Medicare PIN