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NPI Code Detail

MEDICARE: RAYMOND LEE STILLWELL MD

MEDICARE: RAYMOND LEE STILLWELL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician10160NV
2207P00000XEmergency Medicine PhysicianA70591CA

General Provider Information

NPI Number : 1427056845
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAYMOND LEE STILLWELL MD
Provider Business Mailing Address
First Line : 1111 EMERALD BAY RD
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96150-6207
Country : US
Telephone Number : 530-543-5659
Fax Number : 530-541-8723
Provider Business Practice Location Address
First Line : 2170 SOUTH AVE
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96150-7026
Country : US
Telephone Number : 530-541-3420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2005
Last Update Date : 03/17/2018

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Directions to “ RAYMOND LEE STILLWELL MD” Practice Location

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