Provider Demographics
NPI:1265660633
Name:RANEY, JEREMIAH JEDD (DO)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:JEDD
Last Name:RANEY
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 1:2402 W PIERCE
Mailing Address - Street 2:#3C
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220
Mailing Address - Country:US
Mailing Address - Phone:575-887-0530
Mailing Address - Fax:575-885-6309
Practice Address - Street 1:2402 W PIERCE
Practice Address - Street 2:#3C
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220
Practice Address - Country:US
Practice Address - Phone:575-887-0530
Practice Address - Fax:575-885-6309
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NMA-1662-12208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program