Provider Demographics
NPI:1164405015
Name:RAYMOND, THOMAS MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARTIN
Last Name:RAYMOND
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 1:1447 N. HARRISON
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3287
Mailing Address - Country:US
Mailing Address - Phone:989-791-7916
Mailing Address - Fax:989-791-7961
Practice Address - Street 1:3350 SHATTUCK RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3287
Practice Address - Country:US
Practice Address - Phone:989-791-7916
Practice Address - Fax:989-791-7961
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048101208100000X
TXJ2751208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089951001Medicaid
MIM74750251Medicare PIN
TX089951001Medicaid
TX00K21KMedicare PIN