Provider Demographics
NPI:1245524172
Name:RAPP, ELLIOT JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:JAMES
Last Name:RAPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:E.
Other - Middle Name:JAMES
Other - Last Name:RAPP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1959 NE PACIFIC ST # NW001
Mailing Address - Street 2:BOX 357115
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-7115
Mailing Address - Country:US
Mailing Address - Phone:206-598-6483
Mailing Address - Fax:
Practice Address - Street 1:3100 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5746
Practice Address - Country:US
Practice Address - Phone:907-228-7644
Practice Address - Fax:907-228-8337
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA247742390200000X
AK2114382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program