Provider Demographics
NPI:1942352760
Name:ROBERTS, RAYMOND G (DPM)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:G
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3495 LAKESIDE DR
Mailing Address - Street 2:#243
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4841
Mailing Address - Country:US
Mailing Address - Phone:775-825-2533
Mailing Address - Fax:775-825-1263
Practice Address - Street 1:6580 S MCCARRAN BLVD
Practice Address - Street 2:STE. D-1
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6112
Practice Address - Country:US
Practice Address - Phone:775-825-2533
Practice Address - Fax:775-826-9546
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV9004213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV37459Medicare PIN
NVU17150Medicare UPIN
NVV37417Medicare PIN
NVV37417Medicare ID - Type UnspecifiedMEDICARE PRACTICE ID