Provider Demographics
NPI:1730106576
Name:POOR, RAYMOND JOHN (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOHN
Last Name:POOR
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 1:6200 SHINGLE CREEK PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2128
Mailing Address - Country:US
Mailing Address - Phone:763-561-5349
Mailing Address - Fax:
Practice Address - Street 1:2085 RICE ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-6807
Practice Address - Country:US
Practice Address - Phone:651-489-9035
Practice Address - Fax:651-489-6373
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45375207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1835219OtherAMERICA'S PPO
MN1034201OtherPREFERRED ONE
MN211914500Medicaid
164081C028OtherUCARE
MN3100162OtherMEDICA
WI34354500Medicaid
MN428S0POOtherBCBSMN
MNHP37229OtherHEALTHPARTNERS
MN211914500Medicaid
MN1835219OtherAMERICA'S PPO
MNHP37229OtherHEALTHPARTNERS