Provider Demographics
NPI:1861447641
Name:WESTERMEYER, RAYMOND E (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:E
Last Name:WESTERMEYER
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 1:55 TWIN OAKS AVE
Mailing Address - Street 2:SUITE #A-1
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-2864
Mailing Address - Country:US
Mailing Address - Phone:541-451-6920
Mailing Address - Fax:541-451-6924
Practice Address - Street 1:55 TWIN OAKS AVE
Practice Address - Street 2:SUITE #A-1
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2864
Practice Address - Country:US
Practice Address - Phone:541-451-6920
Practice Address - Fax:541-451-6924
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR044438Medicaid
OR133103Medicare ID - Type Unspecified
OR044438Medicaid