Provider Demographics
NPI:1184661522
Name:SJERVEN, RAYMOND HERBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:HERBERT
Last Name:SJERVEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 S AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5661
Mailing Address - Country:US
Mailing Address - Phone:509-586-8986
Mailing Address - Fax:509-586-0314
Practice Address - Street 1:813 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5661
Practice Address - Country:US
Practice Address - Phone:509-586-8986
Practice Address - Fax:509-586-0314
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1388800Medicaid
WAG8862699Medicare PIN
WAG8862700Medicare PIN
WAE23502Medicare UPIN