Provider Demographics
NPI:1346550936
Name:MARTIN N RAITIERE MD
Entity Type:Organization
Organization Name:MARTIN N RAITIERE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROVIDER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:RAITIERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-292-4538
Mailing Address - Street 1:PO BOX 87670
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98687-7670
Mailing Address - Country:US
Mailing Address - Phone:503-292-4538
Mailing Address - Fax:503-292-2560
Practice Address - Street 1:9900 SW WILSHIRE ST
Practice Address - Street 2:STE 220
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5035
Practice Address - Country:US
Practice Address - Phone:503-292-4538
Practice Address - Fax:503-292-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR162442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR043380Medicaid
OR043380Medicaid