Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301083444 | MI |
N | 111NI0900X | Internist | 4301083444 | MI |
Y | 207RI0200X | Infectious Disease | 5315042575 | MI |
NPI | 1063623981 |
---|---|
Provider Name | Dr. Jose Luis Raygada |
First Address | Alma, MI 48801-1092 |
Second Address | Alma, MI 48801-1092 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 20/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1051580 | MCLAREN (01) | MI |
1103700032 | BCBSM (01) | MI |
200000021994 | PHP COMMERCIAL (01) | MI |