Provider Demographics
NPI:1750116133
Name:RAYMOS, DOUGLAS FRANKLIN
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:FRANKLIN
Last Name:RAYMOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 PARKWAY DR APT B
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:ND
Mailing Address - Zip Code:58722-2051
Mailing Address - Country:US
Mailing Address - Phone:701-500-5293
Mailing Address - Fax:
Practice Address - Street 1:409 PARKWAY DR APT B
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:ND
Practice Address - Zip Code:58722-2051
Practice Address - Country:US
Practice Address - Phone:701-500-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No374U00000XNursing Service Related ProvidersHome Health Aide