Provider Demographics
NPI:1912075920
Name:RAYMOND, PAUL D (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:RAYMOND
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 1:510 W TUDOR RD STE 5
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6649
Mailing Address - Country:US
Mailing Address - Phone:907-743-0050
Mailing Address - Fax:907-743-0060
Practice Address - Street 1:323 W DANVIEW AVE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7028
Practice Address - Country:US
Practice Address - Phone:907-235-0000
Practice Address - Fax:907-235-4050
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA2281207QS1201X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1011363Medicaid
AKMD2281Medicaid
AKMD22812Medicaid
AKK00WCRBGAMedicare ID - Type UnspecifiedMEDICARE NUMBER
AKK152108Medicare ID - Type UnspecifiedMEDICARE REDOUBT MEDICAL