Provider Demographics
NPI:1750333142
Name:RAISER, FREDERICK C III (DO)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:C
Last Name:RAISER
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2797
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2797
Mailing Address - Country:US
Mailing Address - Phone:402-354-4230
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:8303 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4108
Practice Address - Country:US
Practice Address - Phone:402-354-4424
Practice Address - Fax:402-354-4435
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE782207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037660412Medicaid
IA1750333142Medicaid
NE096573094Medicare PIN
RA4133751Medicare PIN
000000329989OtherBCBS
OH000000493512OtherANTHEM/BCBS
I07044Medicare UPIN
OH2489132Medicaid
OHP00166214Medicare PIN