Individual
DR. RAEGAN MARIE VANDERPUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(602) 933-0777
(602) 933-0755
Mailing address
3200 E CAMELBACK RD, STE 250, PHOENIX, AZ 85018-2327
(602) 933-1814
(602) 933-1820
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
45721
AZ
208000000X
Pediatrics Physician
45721
AZ
208M00000X
Hospitalist Physician
Primary
45721
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
726075
—
AZ
Enumeration date
06/19/2008
Last updated
04/03/2017
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