Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 9196 | TX |
Y | 111NX0100X | Occupational Health | 9196 | TX |
NPI | 1457348997 |
---|---|
Provider Name | Dr. Paul Michael Raymond |
First Address | Houston, TX 77031-3602 |
Second Address | Houston, TX 77031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 13/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8M8542 | BCBS NUMBER (01) | TX |
U96293 | (02) | TX |