Provider Demographics
NPI:1598709412
Name:JOHN RAYMOND MD PC
Entity Type:Organization
Organization Name:JOHN RAYMOND MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-723-2044
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0315
Mailing Address - Country:US
Mailing Address - Phone:231-775-7405
Mailing Address - Fax:231-775-0027
Practice Address - Street 1:1465 E PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9709
Practice Address - Country:US
Practice Address - Phone:231-398-1147
Practice Address - Fax:231-398-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N65290Medicare ID - Type Unspecified