Provider Demographics
NPI:1649249723
Name:RAYMOND, MARK C (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:RAYMOND
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Other - Last Name Type:
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Mailing Address - Street 1:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5010
Mailing Address - Country:US
Mailing Address - Phone:701-718-8000
Mailing Address - Fax:701-857-3430
Practice Address - Street 1:1321 W DAKOTA PKWY
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3807
Practice Address - Country:US
Practice Address - Phone:701-572-7641
Practice Address - Fax:701-572-3910
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND10592207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006301231Medicaid
VA006301231Medicaid
F64780Medicare UPIN