Provider Demographics
NPI:1366550923
Name:RAINES, JEFFREY L
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:RAINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:14500 99TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4730
Practice Address - Country:US
Practice Address - Phone:763-898-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44383207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0702163OtherMEDICA
MN1493817OtherAMERICA'S PPO
MN7760362OtherAETNA INS
MN50G94RAOtherBCBS OF MN
MN1029424OtherPREFERRED ONE
MN141532OtherUCARE MN
MN382151000Medicaid
MNHP34719OtherHEALTHPARTNERS
MN1029424OtherPREFERRED ONE
MN160001973Medicare ID - Type UnspecifiedWPS MEDICARE
MN160056020Medicare ID - Type UnspecifiedRAILROAD MEDICARE