Provider Demographics
NPI:1013047703
Name:STRUCK, RAYMOND L (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:L
Last Name:STRUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAYMOND
Other - Middle Name:L
Other - Last Name:STRUCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1030
Mailing Address - Country:US
Mailing Address - Phone:601-264-2111
Mailing Address - Fax:601-584-4053
Practice Address - Street 1:103 S 19TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6171
Practice Address - Country:US
Practice Address - Phone:601-544-4641
Practice Address - Fax:601-582-1607
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS173572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry