Provider Demographics
NPI:1477550622
Name:TARAZI, RAED F (MD)
Entity Type:Individual
Prefix:DR
First Name:RAED
Middle Name:F
Last Name:TARAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4023
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-4023
Mailing Address - Country:US
Mailing Address - Phone:480-240-7391
Mailing Address - Fax:480-240-7391
Practice Address - Street 1:9475 E IRONWOOD SQUARE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4576
Practice Address - Country:US
Practice Address - Phone:480-240-7391
Practice Address - Fax:480-240-7391
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34222208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ106285Medicare PIN
G23729Medicare UPIN