Provider Demographics
NPI:1932169547
Name:STANIUNAS, RAYMOND JUDE (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JUDE
Last Name:STANIUNAS
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 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:6029 WALNUT GROVE RD STE 210
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2112
Practice Address - Country:US
Practice Address - Phone:901-226-2960
Practice Address - Fax:901-226-2982
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS27346208C00000X
TN60217208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105461107Medicaid
TX105461106Medicaid
TXTXB123075Medicare PIN
TX105461106Medicaid
TXTXB115236Medicare PIN
TXTXB122511Medicare PIN
TX105461107Medicaid