Provider Demographics
NPI:1063504454
Name:DEICKEN, RAYMOND FRIEDRICH (MS, MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:FRIEDRICH
Last Name:DEICKEN
Suffix:
Gender:M
Credentials:MS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PARKRIDGE DR.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-1424
Mailing Address - Country:US
Mailing Address - Phone:415-401-6642
Mailing Address - Fax:
Practice Address - Street 1:90 PARKRIDGE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-1490
Practice Address - Country:US
Practice Address - Phone:415-401-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG560072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G560070OtherPIN
CA00G560070OtherPIN