Provider Demographics
NPI:1215291604
Name:ALT, RACHEL (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:ALT
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:ONE HOSPITAL DRIVE, DCO75.00, MC424
Mailing Address - Street 2:UNIVERSITY OF MISSOURI, DEPARTMENT OF SURGERY
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212
Mailing Address - Country:US
Mailing Address - Phone:573-884-2000
Mailing Address - Fax:573-884-6024
Practice Address - Street 1:5994 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9462
Practice Address - Country:US
Practice Address - Phone:928-425-7108
Practice Address - Fax:928-425-7925
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012017801208600000X
AZ58890208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005495Medicaid
MO2012017801OtherMEDICAL LICENSE NUMBER