Provider Demographics
NPI:1417521162
Name:RISSER, RAYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYCE
Middle Name:
Last Name:RISSER
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 1:123 W PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45830-1225
Mailing Address - Country:US
Mailing Address - Phone:419-231-1136
Mailing Address - Fax:
Practice Address - Street 1:2D RECONNAISSANCE BATTALION AID STATION
Practice Address - Street 2:A-17 COURTHOUSE BAY
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:419-231-1136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTG980100208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice