Provider Demographics
NPI:1568414258
Name:RAINES, EDWARD P (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:P
Last Name:RAINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:P
Other - Last Name:RAINES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5348 WILDCAT CT
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-2197
Mailing Address - Country:US
Mailing Address - Phone:402-730-9232
Mailing Address - Fax:
Practice Address - Street 1:110 N 29TH ST
Practice Address - Street 2:STE 302
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4424
Practice Address - Country:US
Practice Address - Phone:402-844-8242
Practice Address - Fax:402-844-8233
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18481208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEE98010Medicare UPIN
NE274831Medicare ID - Type Unspecified