Individual
GEORGE H RAQUE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
210 E GRAY ST, STE 1105, LOUISVILLE, KY 40202-3900
(502) 583-1697
(502) 583-2120
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
23410
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000604409
NORTONANTHEM
—
01
—
00023035K
HUMANA/NNIKY
—
01
—
012947
NORTON-SIHO
—
05
—
100373960
—
IN
01
—
64234107
KY MEDICAID/NIKY
—
Enumeration date
08/24/2005
Last updated
09/02/2016
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