Healthcare Provider Details

I. General information

NPI: 1609835180
Provider Name (Legal Business Name): JOHN H RAIFE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

PO BOX 15070
SCOTTSDALE AZ
85267-5070
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-6968
  • Fax: 602-839-4144
Mailing address:
  • Phone: 480-421-9700
  • Fax: 480-421-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9460
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: