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Individual

DR. BRADLEY D RAISHER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
201 CEDAR, SUITE 700, ALBUQUERQUE, NM 87106
(505) 848-3700
(505) 848-3703
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222

Taxonomy

Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
96345
NM
2080P0202X
Pediatric Cardiology Physician
M11905
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
L0722
NM
Enumeration date
05/03/2006
Last updated
02/06/2014
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