Provider Demographics
NPI:1649378530
Name:RAUH, J RANDALL (MD)
Entity type:Individual
Prefix:
First Name:J
Middle Name:RANDALL
Last Name:RAUH
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 1:330 ROGER LN
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-9239
Mailing Address - Country:US
Mailing Address - Phone:406-234-7660
Mailing Address - Fax:
Practice Address - Street 1:330 ROGER LN
Practice Address - Street 2:SUITE 4
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-9239
Practice Address - Country:US
Practice Address - Phone:406-234-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4606207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0076993OtherMDCD PIN
WY113957600OtherMDCD PIN
MT000097685OtherBCBS PIN
MT000097685OtherBCBS PIN
MT000084094Medicare PIN
MTD07937Medicare UPIN
MTP00161386Medicare PIN
MT1153260004Medicare PIN