Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 18867 | SC |
Y | 207RN0300X | Nephrologist | 61052 | WI |
NPI | 1043328099 |
---|---|
Provider Name | John R Raymond SR. |
First Address | Milwaukee, WI 53226-0509 |
Second Address | Milwaukee, WI 53226-0509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 15/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043328099 | (05) | WI |
188674 | (05) | SC |
C86113 | (02) |