Provider Demographics
NPI:1477646362
Name:OBREGON, RAIMUNDO L (MD)
Entity Type:Individual
Prefix:DR
First Name:RAIMUNDO
Middle Name:L
Last Name:OBREGON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1308 MORRIS AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3331
Mailing Address - Country:US
Mailing Address - Phone:908-688-8855
Mailing Address - Fax:908-688-9282
Practice Address - Street 1:1308 MORRIS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3331
Practice Address - Country:US
Practice Address - Phone:908-688-8855
Practice Address - Fax:908-688-9282
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ41057207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3613500Medicaid
NJ3613500Medicaid