MEDICARE: RAYMOND B DEMOVILLE 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
1	207Y00000X	Otolaryngology Physician	MD0000034182	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	103I045255	OTHER	TN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6123764	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1699770016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND B DEMOVILLE MD

Provider Business Mailing Address
First Line	:	3024 BUSINESS PARK CIR
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-3132
Country	:	US
Telephone Number	:	615-239-2018
Fax Number	:	615-851-2018

Provider Business Practice Location Address
First Line	:	1525 HUNT CLUB BLVD STE 100
Second Line	:
City	:	GALLATIN
State	:	TN
Zip	:	37066-6070
Country	:	US
Telephone Number	:	615-822-2177
Fax Number	:	615-822-0300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	04/21/2026

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Directions to “ RAYMOND B DEMOVILLE MD” Practice Location

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