Provider Demographics
NPI:1073689626
Name:DELILLE, RAYMOND JOSEPH SR (PA)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:JOSEPH
Last Name:DELILLE
Suffix:SR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:SANDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:79848-0127
Mailing Address - Country:US
Mailing Address - Phone:432-345-6734
Mailing Address - Fax:432-345-2426
Practice Address - Street 1:213 PERSIMMON
Practice Address - Street 2:
Practice Address - City:SANDERSON
Practice Address - State:TX
Practice Address - Zip Code:79848-0244
Practice Address - Country:US
Practice Address - Phone:432-345-2508
Practice Address - Fax:432-345-2426
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00910363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16166308OtherINDIV NPI
TX8N4928OtherPA BCBS
TX451954Medicare ID - Type Unspecified
TX16166308OtherINDIV NPI