Provider Demographics
NPI:1508817719
Name:VALDES, RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:VALDES
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 1:208 SHOPPINGWAY BLVD STE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-1734
Mailing Address - Country:US
Mailing Address - Phone:870-733-1280
Mailing Address - Fax:877-441-0008
Practice Address - Street 1:208 SHOPPINGWAY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1734
Practice Address - Country:US
Practice Address - Phone:870-733-1280
Practice Address - Fax:870-733-9443
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000034563207R00000X
AR0E2536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140122001Medicaid
LA1782327Medicaid
ARH07547Medicare UPIN
AR140122001Medicaid
LA1782327Medicaid