MEDICARE: COLIN R RAITIERE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	19619	KY
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	19619	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00156824	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000000323180	OTHER	KY	ANTHEM BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114998440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLIN R RAITIERE MD

Provider Business Mailing Address
First Line	:	120 ENTERPRISE DR
Second Line	:
City	:	DANVILLE
State	:	KY
Zip	:	40422-1870
Country	:	US
Telephone Number	:	859-236-2425
Fax Number	:	859-757-2475

Provider Business Practice Location Address
First Line	:	120 ENTERPRISE DR
Second Line	:
City	:	DANVILLE
State	:	KY
Zip	:	40422-1870
Country	:	US
Telephone Number	:	859-236-2425
Fax Number	:	859-757-2475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/30/2010

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Directions to “ COLIN R RAITIERE MD” Practice Location

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