Provider Demographics
NPI:1366502858
Name:HOWARD, RAYMOND LAWRENCE SR
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:LAWRENCE
Last Name:HOWARD
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RAYMOND
Other - Middle Name:LAWRENCE
Other - Last Name:HOWARD
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:NAVY CORPSMAN
Mailing Address - Street 1:1101 BARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-2312
Mailing Address - Country:US
Mailing Address - Phone:224-757-5186
Mailing Address - Fax:
Practice Address - Street 1:3001 6TH ST STE A
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-2833
Practice Address - Country:US
Practice Address - Phone:847-688-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman