MEDICARE: DR. GARY W RAAB D.O.

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	MB048583	NJ

Other Identifiers

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

General Provider Information

NPI Number	:	1972683001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY W RAAB D.O.

Provider Business Mailing Address
First Line	:	500 E 6TH ST
Second Line	:
City	:	OCEAN CITY
State	:	NJ
Zip	:	08226-3826
Country	:	US
Telephone Number	:	609-399-1862
Fax Number	:	609-399-1572

Provider Business Practice Location Address
First Line	:	500 E 6TH ST
Second Line	:
City	:	OCEAN CITY
State	:	NJ
Zip	:	08226-3826
Country	:	US
Telephone Number	:	609-399-1862
Fax Number	:	609-399-1572

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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