Provider Demographics
NPI:1174842678
Name:RAYMOND, ROBERSON (RT, RDMS)
Entity Type:Individual
Prefix:MR
First Name:ROBERSON
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:RT, RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 ARTHURIUM AVE
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3431
Mailing Address - Country:US
Mailing Address - Phone:561-503-6331
Mailing Address - Fax:
Practice Address - Street 1:4123 ARTHURIUM AVE
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-3431
Practice Address - Country:US
Practice Address - Phone:561-503-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT 335692471C3402X
FL372182471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography