Provider Demographics
NPI:1629048608
Name:RAINES, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:RAINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 E. HIGHLAND AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4876
Mailing Address - Country:US
Mailing Address - Phone:602-257-4219
Mailing Address - Fax:602-257-8319
Practice Address - Street 1:2222 E. HIGHLAND AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4876
Practice Address - Country:US
Practice Address - Phone:602-257-4219
Practice Address - Fax:602-257-8319
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11267207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ799702Medicaid
AZ231283Medicaid
AZAZ0819110OtherBC/BS PROVIDER ID
AZ231283Medicaid
AZAZ0819110OtherBC/BS PROVIDER ID
23388Medicare PIN