Provider Demographics
NPI:1396733705
Name:ALLEN, RAYMOND H (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:H
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5009
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5009
Mailing Address - Country:US
Mailing Address - Phone:605-977-5000
Mailing Address - Fax:
Practice Address - Street 1:4520 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8148
Practice Address - Country:US
Practice Address - Phone:605-977-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1565207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6001940Medicaid
24680OtherHEALTH PARTNERS
MN1M495ALOtherMN BCBS - PLAN 91057NO
SD1565OtherDAKOTACARE
IA0931972Medicaid
MN925590700Medicaid
SD931451029027OtherPREFERRED ONE
MN538R7ALOtherMN BCBS - PLAN 538R2NO
SD0000537OtherSD BCBS
MN120334OtherUCARE
IA53984OtherIA BCBS
MN120334OtherUCARE
MN1M495ALOtherMN BCBS - PLAN 91057NO
SD6001940Medicaid
SDS537Medicare PIN
SD931451029027OtherPREFERRED ONE