Basic Information
| Provider Information | |||||||||
| NPI: | 1235225285 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYAPATI | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 826 SE MARINE DR | ||||||||
| Address2: | |||||||||
| City: | COLLEGE PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993244000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095250904 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 77 WAINWRIGHT DR | ||||||||
| Address2: | |||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993623975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095255200 | ||||||||
| FaxNumber: | 5095266204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 037345 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 037345 | 01 | GA | STATE MEDICAL LICENSE NUM | OTHER |