Healthcare Provider Details

I. General information

NPI: 1356776454
Provider Name (Legal Business Name): JOHN HART RAAF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2013
Last Update Date: 09/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 FAIRHILL RD
CLEVELAND OH
44120-1017
US

IV. Provider business mailing address

0225 SW MONTGOMERY ST #5
PORTLAND OR
97201-5159
US

V. Phone/Fax

Practice location:
  • Phone: 503-333-5969
  • Fax:
Mailing address:
  • Phone: 503-333-5969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number35.051683
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: