Jack Michael Raisanen MD

NPI 1083673115 - Pathology - 207ZN0500X

NPI Details
NPI 1083673115
Gender Male
Enumeration Date 03/18/2006
Last Updated 12/01/2007
Entity Type Individual
Active Over 11 years ago
Practice Location
5323 HARRY HINES BLVD
DALLAS TX, 75390-7208, US
Phone (214) 648-1620
Fax (214) 648-4080
Business Location
PO BOX 845347
DALLAS TX, 75284-5347, US
Phone (214) 648-1620
Fax (214) 648-4080
Toxanomy
Taxonomy Code 207ZN0500X
License State Texas
License Number L1177
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According to our database, Dr. Jack Michael Raisanen MD NPI is 1083673115, taxonomy code is 207ZN0500X and license number is L1177, license state is located at Texas. Jack Michael Raisanen MD physically located at 5323 Harry Hines Blvd, Dallas TX, 75390-7208. NPI Number Jack Michael Raisanen MD has the Individual type.

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1083673115 NPI number is provided on an as is basis without warranty of any kind. 1083673115 is maintained by the National Plan & Provider Enumeration System. The contents of Jack Michael Raisanen MD are for informational purposes only.