Provider Demographics
NPI:1891735478
Name:CAPPS, RAYMOND LUIS (MD,PA)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LUIS
Last Name:CAPPS
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 N. BELTLINE RD. SUITE 104
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-1782
Mailing Address - Country:US
Mailing Address - Phone:972-285-8981
Mailing Address - Fax:972-216-5845
Practice Address - Street 1:1050 N BELT LINE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1782
Practice Address - Country:US
Practice Address - Phone:972-285-8981
Practice Address - Fax:972-216-5845
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5277707OtherAETNA
TXG83366Medicare UPIN
TX5277707OtherAETNA