Provider Demographics
NPI:1942204367
Name:RAYMOND, GARY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4165
Mailing Address - Country:US
Mailing Address - Phone:814-943-3668
Mailing Address - Fax:814-942-7635
Practice Address - Street 1:711 LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4165
Practice Address - Country:US
Practice Address - Phone:814-943-3668
Practice Address - Fax:814-942-7635
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002487L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009025880006Medicaid
PA399941327OtherGEISINGER
PA99382OtherHEALTH AMERICA
PA251753069OtherAETNA
PA1019736OtherGATEWAY
PARA430959OtherBC/BS
PA599562Medicare PIN