Provider Demographics
NPI:1831178433
Name:SHAMOS, RAYMOND FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:FRANK
Last Name:SHAMOS
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 1:500 W THOMAS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4224
Mailing Address - Country:US
Mailing Address - Phone:602-266-4493
Mailing Address - Fax:602-264-1577
Practice Address - Street 1:500 W THOMAS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4224
Practice Address - Country:US
Practice Address - Phone:602-266-4493
Practice Address - Fax:602-264-1577
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13612208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
233669-01OtherAHCCHS PROVIDER
233669-01OtherAHCCHS PROVIDER
D37631Medicare UPIN