Healthcare Provider Details

I. General information

NPI: 1629048608
Provider Name (Legal Business Name): JOHN M RAINES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E. HIGHLAND AVE SUITE 204
PHOENIX AZ
85016-4876
US

IV. Provider business mailing address

2222 E. HIGHLAND AVE SUITE 204
PHOENIX AZ
85016-4876
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-4219
  • Fax: 602-257-8319
Mailing address:
  • Phone: 602-257-4219
  • Fax: 602-257-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number11267
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: