Provider Demographics
NPI:1376580597
Name:VILLALOBOS, RAYMOND M (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:M
Last Name:VILLALOBOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:VILLALOBOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:168 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-5402
Mailing Address - Country:US
Mailing Address - Phone:508-523-4218
Mailing Address - Fax:
Practice Address - Street 1:715 S COWLEY ST STE 210
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-473-6706
Practice Address - Fax:509-473-6704
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78395208100000X
RIMD17230208100000X
WAMD00030129208100000X
MT78914208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3175839Medicaid
MAF69843Medicare UPIN