Basic Information
| Provider Information | |||||||||
| NPI: | 1568414258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAINES | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAINES | ||||||||
| OtherFirstName: | EDWARD | ||||||||
| OtherMiddleName: | P | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5348 WILDCAT CT | ||||||||
| Address2: | |||||||||
| City: | MORRISON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804652197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027309232 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 110 N 29TH ST | ||||||||
| Address2: | STE 302 | ||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687014424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028448242 | ||||||||
| FaxNumber: | 4028448233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 02/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 18481 | NE | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | 18481 | NE | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.