Provider Demographics
NPI:1720157274
Name:PIERSON, RAYMOND HAMEL (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:HAMEL
Last Name:PIERSON
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 1:813 COURT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2131
Mailing Address - Country:US
Mailing Address - Phone:209-257-0513
Mailing Address - Fax:209-257-0516
Practice Address - Street 1:813 COURT ST STE 1
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2131
Practice Address - Country:US
Practice Address - Phone:209-257-0513
Practice Address - Fax:209-257-0516
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45467207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG45467OtherLICENSE
CAG45467OtherLICENSE