Provider Demographics
NPI:1073558763
Name:CONNER, RAYMOND MIZE (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:MIZE
Last Name:CONNER
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 1:1535 116TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3812
Mailing Address - Country:US
Mailing Address - Phone:425-455-0244
Mailing Address - Fax:425-455-9411
Practice Address - Street 1:1535 116TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3812
Practice Address - Country:US
Practice Address - Phone:425-455-0244
Practice Address - Fax:425-455-9411
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA18214174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000120813Medicaid
WA000120813Medicaid