Provider Demographics
NPI:1154565539
Name:RAITEN, JOSHU ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHU
Middle Name:ALAN
Last Name:RAITEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4824 MCMAHON BLVD NW STE 109
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5412
Mailing Address - Country:US
Mailing Address - Phone:505-588-7246
Mailing Address - Fax:505-551-1286
Practice Address - Street 1:500 WALTER ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2534
Practice Address - Country:US
Practice Address - Phone:505-727-7177
Practice Address - Fax:505-727-3778
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2020-07-08
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Provider Licenses
StateLicense IDTaxonomies
NMMD20140514208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM24473111Medicaid