Provider Demographics
NPI:1003951351
Name:WAHL, RAYMOND L (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:L
Last Name:WAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 POLO DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3175
Mailing Address - Country:US
Mailing Address - Phone:719-633-1578
Mailing Address - Fax:
Practice Address - Street 1:2502 E PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6033
Practice Address - Country:US
Practice Address - Phone:719-630-6440
Practice Address - Fax:719-228-6603
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine