Provider Demographics
NPI:1043492481
Name:GITA JAFARI-RASKE, M.D., PLLC
Entity type:Organization
Organization Name:GITA JAFARI-RASKE, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFARI-RASKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-926-0170
Mailing Address - Street 1:4802 E RAY RD STE 23-534
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6405
Mailing Address - Country:US
Mailing Address - Phone:480-926-0170
Mailing Address - Fax:
Practice Address - Street 1:4802 E RAY RD
Practice Address - Street 2:SUITE 23-534
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6405
Practice Address - Country:US
Practice Address - Phone:480-926-0170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDG8126OtherRR MEDICARE
AZZ119287Medicare PIN