Provider Demographics
NPI:1588603435
Name:RASQUE, HOPE (MD)
Entity type:Individual
Prefix:
First Name:HOPE
Middle Name:
Last Name:RASQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 1ST ST STE 240
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8308
Mailing Address - Country:US
Mailing Address - Phone:478-633-6900
Mailing Address - Fax:
Practice Address - Street 1:1301 SIGMAN RD NE STE 190
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3924
Practice Address - Country:US
Practice Address - Phone:678-806-3566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004015333208C00000X, 208600000X
GA75125208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209348705Medicaid
189759OtherBLUE CROSS/BLUE SHIELD
MO209348705Medicaid
923114838Medicare ID - Type Unspecified