Healthcare Provider Details

I. General information

NPI: 1336283902
Provider Name (Legal Business Name): ROBERT P RAINES-HEPPLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST UNIVERSITY OF WASHINGTON, BOX 357115
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1473 E STARPASS DR
FRESNO CA
93730-3446
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-3320
  • Fax:
Mailing address:
  • Phone: 206-818-9812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number54370
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA120069
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberML20008736
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberDR.0064656
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: