Provider Demographics
NPI:1548581374
Name:RAECKER, MATTHEW EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EVAN
Last Name:RAECKER
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 1:5901 WESTOWN PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8222
Mailing Address - Country:US
Mailing Address - Phone:515-225-3546
Mailing Address - Fax:515-224-5946
Practice Address - Street 1:5901 WESTOWN PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8222
Practice Address - Country:US
Practice Address - Phone:515-225-3546
Practice Address - Fax:515-224-5946
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-8977207R00000X
390200000X
IAMD-41728207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program