Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | Q6462 | TX |
N | 207RA0401X | Internist - Addiction Medicine | Q6462 | TX |
NPI | 1548671688 |
---|---|
Provider Name | Dr. Miles S Raizada |
First Address | Temple, TX 76508 |
Second Address | Denton, TX 76205-7946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2014 |
Last Update Date | 16/08/2021 |