Provider Demographics
NPI:1699756122
Name:J RAKO MD PC
Entity type:Organization
Organization Name:J RAKO MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JULES
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-586-7334
Mailing Address - Street 1:830 OAK ST
Mailing Address - Street 2:SUITE 200 W
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1168
Mailing Address - Country:US
Mailing Address - Phone:508-586-7334
Mailing Address - Fax:508-583-7599
Practice Address - Street 1:830 OAK ST
Practice Address - Street 2:SUITE 200 W
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1168
Practice Address - Country:US
Practice Address - Phone:508-586-7334
Practice Address - Fax:508-583-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17660OtherBLUE CROSS
MA9703349Medicaid
MA687456OtherTUFTS