Provider Demographics
NPI:1669923728
Name:RAYMIS-DURAN, ADALIE MARIA (PA-C)
Entity type:Individual
Prefix:
First Name:ADALIE
Middle Name:MARIA
Last Name:RAYMIS-DURAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ADALIE
Other - Middle Name:MARIA
Other - Last Name:RAYMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1235 LAKE POINTE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4077
Practice Address - Country:US
Practice Address - Phone:281-665-4444
Practice Address - Fax:281-980-0177
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10830363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX366534103Medicaid