Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 08388 | IA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN18583 | FL |
NPI | 1013920669 |
---|---|
Provider Name | Dr. Gary Martin Raska |
First Address | Sarasota, FL 34231-6541 |
Second Address | Sarasota, FL 34231-6541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 24/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000169002 | PTAN (01) | MO |
0493114 | (05) | IA |