Provider Demographics
NPI:1215291604
Name:ALT, RACHEL (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:ALT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ONE HOSPITAL DRIVE, DCO75.00, MC424
Mailing Address - Street 2:UNIVERSITY OF MISSOURI, DEPARTMENT OF SURGERY
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212
Mailing Address - Country:US
Mailing Address - Phone:573-884-2000
Mailing Address - Fax:573-884-6024
Practice Address - Street 1:ONE HOSPITAL DRIVE, DCO75.00, MC424
Practice Address - Street 2:UNIVERSITY OF MISSOURI, DEPARTMENT OF SURGERY
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212
Practice Address - Country:US
Practice Address - Phone:573-884-2000
Practice Address - Fax:573-884-6024
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2012017801208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012017801OtherMEDICAL LICENSE NUMBER