Provider Demographics
NPI:1043556293
Name:PHILIP A ST RAYMOND MD PLLC
Entity Type:Organization
Organization Name:PHILIP A ST RAYMOND MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:ST RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-453-1800
Mailing Address - Street 1:601 W RIVERSIDE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-5119
Mailing Address - Country:US
Mailing Address - Phone:928-453-1800
Mailing Address - Fax:928-453-1804
Practice Address - Street 1:601 W RIVERSIDE DR STE 3
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5119
Practice Address - Country:US
Practice Address - Phone:928-453-1800
Practice Address - Fax:928-453-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14335208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty