Provider Demographics
NPI:1386656106
Name:FUCHS, RAYMOND MARCUS (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:MARCUS
Last Name:FUCHS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W GRAY ST
Mailing Address - Street 2:SUITE#518
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7129
Mailing Address - Country:US
Mailing Address - Phone:405-217-2964
Mailing Address - Fax:405-217-2408
Practice Address - Street 1:330 W GRAY ST
Practice Address - Street 2:SUITE#518
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7129
Practice Address - Country:US
Practice Address - Phone:405-217-2964
Practice Address - Fax:405-217-2408
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK577103T00000X, 103TC2200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200093410AMedicaid