Provider Demographics
NPI:1760585152
Name:FLETCHER, RAYMOND R (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:R
Last Name:FLETCHER
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:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36536-1090
Mailing Address - Country:US
Mailing Address - Phone:251-943-2642
Mailing Address - Fax:251-943-3876
Practice Address - Street 1:1450 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36536-1090
Practice Address - Country:US
Practice Address - Phone:251-943-2641
Practice Address - Fax:251-943-3876
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12660207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51085762OtherBC OF AL
AL000085762Medicaid
B64207Medicare UPIN
AL000085762Medicare ID - Type Unspecified