Provider Demographics
NPI:1386612653
Name:RAPP, JEFFREY B (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:RAPP
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:COMMUNITY MEMORIAL HOSPITAL
Mailing Address - Street 2:512 SKYLINE BLVD
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1199
Mailing Address - Country:US
Mailing Address - Phone:218-879-4641
Mailing Address - Fax:218-927-4130
Practice Address - Street 1:COMMUNITY MEMORIAL HOSPITAL
Practice Address - Street 2:512 SKYLINE BLVD
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1199
Practice Address - Country:US
Practice Address - Phone:218-879-4641
Practice Address - Fax:218-927-4130
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42724207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN080015004OtherMEDICARE WPS - MCGREGOR C
MN080009937OtherMEDICARE WPS - HOSPITAL
MN080011425OtherMEDICARE WPS - AITKIN CLI
MN829625100Medicaid