Provider Demographics
NPI:1164643789
Name:RAYMER, KEVIN KYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KYLE
Last Name:RAYMER
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:PO BOX 859
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85547-0859
Mailing Address - Country:US
Mailing Address - Phone:928-472-4675
Mailing Address - Fax:928-472-3431
Practice Address - Street 1:126 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5488
Practice Address - Country:US
Practice Address - Phone:928-472-4675
Practice Address - Fax:928-472-3431
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-32629207Q00000X
AZ44721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110150004OtherMEDICARE
AZ623101Medicaid
KS200573240AMedicaid
KS110171004OtherMEDICARE
KS110150004OtherMEDICARE