Basic Information
| Provider Information | |||||||||
| NPI: | 1396725271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAISER | ||||||||
| FirstName: | SHELBY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1821 | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437021821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404553304 | ||||||||
| FaxNumber: | 7404553686 | ||||||||
| Practice Location | |||||||||
| Address1: | 41 FOSTER DR | ||||||||
| Address2: | |||||||||
| City: | THORNVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430768010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402466361 | ||||||||
| FaxNumber: | 7402464722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 05/01/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34008545 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000592373 | 01 | ANTHEM | OTHER | 311518750029 | 01 | OH | CARESOURCE | OTHER | 2622899 | 05 | OH | MEDICAID |