Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 10339 | NV |
NPI | 1770561961 |
---|---|
Provider Name | Dr. Abdi Raissi |
First Address | Las Vegas, NV 89121-3609 |
Second Address | Las Vegas, NV 89121-3609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 02/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200045560 | R.R. MEDICARE (01) | |
2018729 | (05) | NV |
7281120 | AETNA (01) | |
CC6017 | BXBS (01) | |
H10274 | (02) |