Provider Demographics
NPI:1225509045
Name:RAICHE, JOHN N
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:RAICHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 S EATON ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3548
Mailing Address - Country:US
Mailing Address - Phone:720-987-0025
Mailing Address - Fax:
Practice Address - Street 1:1648 GAYLORD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1239
Practice Address - Country:US
Practice Address - Phone:303-333-4288
Practice Address - Fax:303-336-1632
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist