Provider Demographics
NPI:1275560781
Name:RAICHE, MIRANDA MCINTYRE (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:MCINTYRE
Last Name:RAICHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-1316
Mailing Address - Country:US
Mailing Address - Phone:509-548-3431
Mailing Address - Fax:509-548-2510
Practice Address - Street 1:529 JASMINE ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9589
Practice Address - Country:US
Practice Address - Phone:509-826-1600
Practice Address - Fax:509-826-3633
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8457434Medicaid
WA0211040OtherL&I
WA8457434Medicaid
WA0211040OtherL&I