Vanderput, Raegan Marie

Vanderput, Raegan Marie is an individual health care provider with primary practice located at 1919 E Thomas Rd , Phoenix AZ 85016-7710. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Hospitalist is her primary health care specialty. Vanderput, Raegan Marie can be contacted via phone (602) 933-0777.

Contact Information

Primary practice address
1919 E Thomas Rd Phoenix AZ 85016-7710
Phone: (602) 933-0777
Fax: (602) 933-0755
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 45721 Arizona
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 45721 Arizona
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X 45721 Arizona

Profile Details

NPI number 1962663161
LBN Legal business name Vanderput, Raegan Marie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 19th, 2008
Last updated Apr 3rd, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962663161 NPPES
Arizona MEDICAID 726075

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