Basic Information
| Provider Information | |||||||||
| NPI: | 1528006806 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAKOV | ||||||||
| FirstName: | NEAL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91550 OVERSEAS HIGHWAY | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | TAVERNIER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330702141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058529400 | ||||||||
| FaxNumber: | 3058526457 | ||||||||
| Practice Location | |||||||||
| Address1: | 933 BRADBURY DR SE STE 2222 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052723120 | ||||||||
| FaxNumber: | 5052728060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 11/27/2018 | ||||||||
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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 | 207RG0100X | ME73295 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 89-90 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 41544 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 252372800 | 05 | FL | MEDICAID | 850372521 | 01 | FL | CHAMPUS | OTHER |