Basic Information
| Provider Information | |||||||||
| NPI: | 1225349715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAISSIAN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | AMIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4612 E GLENROSA AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850184324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154972523 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1955 W FRYE RD | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852246282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807283753 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2010 | ||||||||
| LastUpdateDate: | 11/20/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | R72043 | AZ | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 46595 | AS | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.