Provider Demographics
NPI:1396725271
Name:RAISER, SHELBY K (DO)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:K
Last Name:RAISER
Suffix:
Gender:F
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 1821
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-1821
Mailing Address - Country:US
Mailing Address - Phone:740-455-3304
Mailing Address - Fax:740-455-3686
Practice Address - Street 1:41 FOSTER DR
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076-8010
Practice Address - Country:US
Practice Address - Phone:740-246-6361
Practice Address - Fax:740-246-4722
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000592373OtherANTHEM
OH311518750029OtherCARESOURCE
OH2622899Medicaid
4174203Medicare PIN
000000592373OtherANTHEM