Provider Demographics
NPI:1487703799
Name:RAKER, EDMOND J (MD)
Entity type:Individual
Prefix:
First Name:EDMOND
Middle Name:J
Last Name:RAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:MS:M4-PA
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000199752086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8332405Medicaid
WA0039588OtherLABOR AND INDUSTRIES #
WAUS0861508OtherAETNA SPECIALIST PIN
WA020039454OtherRAILROAD MC#
AKMD784WAMedicaid
WAR038OtherBLUE SHIELD #
WA1487703799OtherMONTANA MEDICAID
WAUS0861508OtherAETNA SPECIALIST PIN
WA020039454OtherRAILROAD MC#
WA8332405Medicaid