Provider Demographics
NPI:1740497379
Name:RAYBON, RONALD H (PA)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:H
Last Name:RAYBON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8201 GOLF COURSE RD NW STE A3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5803
Mailing Address - Country:US
Mailing Address - Phone:505-800-7070
Mailing Address - Fax:
Practice Address - Street 1:5410 W THUNDERBIRD RD STE 101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4711
Practice Address - Country:US
Practice Address - Phone:602-530-6189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant