Provider Demographics
NPI:1750043972
Name:ANDERSON, RAYMOND CHARLES
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:CHARLES
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RAYMOND
Other - Middle Name:CHARLES
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4418 STETSON VW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-5523
Mailing Address - Country:US
Mailing Address - Phone:979-313-0482
Mailing Address - Fax:
Practice Address - Street 1:4418 STETSON VW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-5523
Practice Address - Country:US
Practice Address - Phone:979-313-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program