Provider Demographics
NPI:1760465850
Name:COORS, RAYMOND B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:B
Last Name:COORS
Suffix:JR
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 1:4685 FOREST AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-246-7000
Mailing Address - Fax:
Practice Address - Street 1:9070 WINTON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3828
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-728-4344
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040831174400000X
OH35.040831207Y00000X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4026133OtherAETNA ID
OH1020172OtherUNITED HEALTHCARE ID
OH0585488Medicaid
OH000000008695OtherANTHEM ID
OH4033107OtherHUMANA ID
OH000000008695OtherANTHEM ID