Provider Demographics
NPI:1295904183
Name:RAYMOND ROBERTS, DPM, LTD
Entity type:Organization
Organization Name:RAYMOND ROBERTS, DPM, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:775-825-2533
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9004213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU17150Medicare UPIN
NVV37417Medicare PIN
NV37459Medicare PIN