Provider Demographics
NPI:1386643641
Name:RAYNAK, JOSEPH FRANK (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FRANK
Last Name:RAYNAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-972-9590
Practice Address - Street 1:20325 N 51ST AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5674
Practice Address - Country:US
Practice Address - Phone:623-249-4928
Practice Address - Fax:623-249-4971
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ172031Medicaid
AZ172031Medicaid