Provider Demographics
NPI:1083674857
Name:BOTTE, RAYMOND R (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:R
Last Name:BOTTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3010 E KERRY LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-2501
Mailing Address - Country:US
Mailing Address - Phone:602-677-2688
Mailing Address - Fax:201-829-4400
Practice Address - Street 1:3815 E BELL RD
Practice Address - Street 2:STE 4300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2122
Practice Address - Country:US
Practice Address - Phone:602-569-2321
Practice Address - Fax:602-569-6220
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ260213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ172453Medicaid
AZ172453Medicaid
AZT78843Medicare UPIN
AZ65489Medicare ID - Type UnspecifiedPODIATRIST