Provider Demographics
NPI:1043328099
Name:RAYMOND, JOHN R SR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:RAYMOND
Suffix:SR
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 1:8701 WATERTOWN PLANK ROAD
Mailing Address - Street 2:OFFICE OF THE PRESIDENT
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-0509
Mailing Address - Country:US
Mailing Address - Phone:414-955-8225
Mailing Address - Fax:414-955-6560
Practice Address - Street 1:8701 WATERTOWN PLANK ROAD
Practice Address - Street 2:OFFICE OF THE PRESIDENT
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-0509
Practice Address - Country:US
Practice Address - Phone:414-955-8225
Practice Address - Fax:414-955-6560
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18867207RN0300X
WI61052207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC188674Medicaid
WI1043328099Medicaid