Provider Demographics
NPI:1265477285
Name:VETSCH, RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:VETSCH
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 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803
Mailing Address - Country:US
Mailing Address - Phone:417-782-3000
Mailing Address - Fax:417-782-3088
Practice Address - Street 1:1102 W 32ND STREET
Practice Address - Street 2:STE 200
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-782-3000
Practice Address - Fax:417-782-3088
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114480208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100313740AMedicaid
MO208522219Medicaid
OK100063690AMedicaid
MO113224OtherANTHEM
330004680OtherRR MEDICARE
MO113224OtherANTHEM
F32191Medicare UPIN