Provider Demographics
NPI:1801878624
Name:VILLANUEVA, RAYMUNDO (MD)
Entity type:Individual
Prefix:
First Name:RAYMUNDO
Middle Name:
Last Name:VILLANUEVA
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 1:2020 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-1000
Mailing Address - Country:US
Mailing Address - Phone:620-227-1371
Mailing Address - Fax:620-227-1208
Practice Address - Street 1:2020 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-1000
Practice Address - Country:US
Practice Address - Phone:620-227-1371
Practice Address - Fax:620-227-1208
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04244652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSVI46145Medicare ID - Type Unspecified
F53478Medicare UPIN