Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 19619 | KY |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 19619 | KY |
NPI | 1114998440 |
---|---|
Provider Name | Colin R Raitiere |
First Address | Danville, KY 40422-1870 |
Second Address | Danville, KY 40422-1870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 30/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000000323180 | ANTHEM BC/BS (01) | KY |
64196199 | (05) | KY |
C74730 | (02) | |
P00156824 | RAILROAD MEDICARE (01) |