Provider Demographics
NPI:1770209405
Name:DAVIS, RAYMOND A II
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:A
Last Name:DAVIS
Suffix:II
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 1:37457 STATE ROUTE 558 LOT 67
Mailing Address - Street 2:
Mailing Address - City:LEETONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44431-9741
Mailing Address - Country:US
Mailing Address - Phone:234-567-1554
Mailing Address - Fax:
Practice Address - Street 1:37457 STATE ROUTE 558 LOT 67
Practice Address - Street 2:
Practice Address - City:LEETONIA
Practice Address - State:OH
Practice Address - Zip Code:44431-9741
Practice Address - Country:US
Practice Address - Phone:234-567-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH79296276Medicaid