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NPI Code Detail

MEDICARE: JOHN RAIZEN MD

MEDICARE: JOHN RAIZEN 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
12084P0804XChild & Adolescent Psychiatry Physician19490OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285798793
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN RAIZEN MD
Provider Business Mailing Address
First Line : 5300 N INDEPENDENCE AVE
Second Line : SUITE 280
City : OKLAHOMA CITY
State : OK
Zip : 73112-5556
Country : US
Telephone Number : 405-427-2441
Fax Number : 405-427-4741
Provider Business Practice Location Address
First Line : 2601 SPENCER RD
Second Line :
City : SPENCER
State : OK
Zip : 73084-3649
Country : US
Telephone Number : 405-427-2441
Fax Number : 405-427-4741
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 07/21/2017

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