Provider Demographics
NPI:1346205655
Name:RAYMOND, FREDERICK M (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:M
Last Name:RAYMOND
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 1:7247 SO PAINTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1451
Mailing Address - Country:US
Mailing Address - Phone:562-945-3589
Mailing Address - Fax:562-945-5788
Practice Address - Street 1:7247 SO PAINTER AVENUE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1451
Practice Address - Country:US
Practice Address - Phone:562-945-3589
Practice Address - Fax:562-945-5788
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32652207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89531Medicare UPIN
CAWG32652AMedicare PIN
CAWG326520Medicare PIN
CAW14783Medicare PIN