MEDICARE: SHELBY K RAISER DO

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	34008545	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000592373	OTHER		ANTHEM
2	311518750029	OTHER	OH	CARESOURCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396725271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY K RAISER DO

Provider Business Mailing Address
First Line	:	PO BOX 1821
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43702-1821
Country	:	US
Telephone Number	:	740-455-3304
Fax Number	:	740-455-3686

Provider Business Practice Location Address
First Line	:	41 FOSTER DR
Second Line	:
City	:	THORNVILLE
State	:	OH
Zip	:	43076-8010
Country	:	US
Telephone Number	:	740-246-6361
Fax Number	:	740-246-4722

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	05/01/2013

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