Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 1714 | OH |
NPI | 1205818408 |
---|---|
Provider Name | Dr. Richard A Raabe |
First Address | Canton, OH 44708-5549 |
Second Address | Canton, OH 44708-5549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 01/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0281716 | (05) | OH |
0785960001 | PTAN (01) | OH |
T80413 | (02) | OH |