Provider Demographics
NPI:1598956781
Name:RAIMER, DAVID NONESUPPLIED (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NONESUPPLIED
Last Name:RAIMER
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 1:2900 DOMINIQUE DR
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-1571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-4906
Practice Address - Country:US
Practice Address - Phone:409-763-2452
Practice Address - Fax:409-763-2458
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.31128207NS0135X
MI4301104398207NS0135X
TXP8983207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00221KMedicare PIN
TX332584YXX1Medicare PIN