Provider Demographics
NPI:1407430556
Name:ALKEBULAN, RAHOTEP ANNU (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:RAHOTEP
Middle Name:ANNU
Last Name:ALKEBULAN
Suffix:
Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:810 LANE AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4785
Practice Address - Country:US
Practice Address - Phone:904-783-9680
Practice Address - Fax:904-390-7464
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME168914207Q00000X
AZR78552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5206948888Medicaid