Provider Demographics
NPI:1407913767
Name:RAYMOND H SJERVEN DO
Entity Type:Organization
Organization Name:RAYMOND H SJERVEN DO
Other - Org Name:8AM TO 8PM FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:SJERVEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-586-8986
Mailing Address - Street 1:813 S AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5661
Mailing Address - Country:US
Mailing Address - Phone:509-586-8986
Mailing Address - Fax:509-586-0314
Practice Address - Street 1:813 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5661
Practice Address - Country:US
Practice Address - Phone:509-586-8986
Practice Address - Fax:509-586-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000807207Q00000X
WAAP30003043363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8862699Medicare PIN