Provider Demographics
NPI:1598961047
Name:RAYMUNDO, BRYAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:D
Last Name:RAYMUNDO
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 1:125 GRIZZLY BEAR DR
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-4782
Mailing Address - Country:US
Mailing Address - Phone:661-714-4008
Mailing Address - Fax:
Practice Address - Street 1:2906 MARKET ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-6881
Practice Address - Country:US
Practice Address - Phone:870-850-8200
Practice Address - Fax:870-850-8245
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine