MEDICARE: DR. JEFFREY T RAIMONDO 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	207Q00000X	Family Medicine Physician	M2027	TX

General Provider Information

NPI Number	:	1740267764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY T RAIMONDO MD

Provider Business Mailing Address
First Line	:	1600 PROVIDENCE DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76707-2261
Country	:	US
Telephone Number	:	254-313-4200
Fax Number	:	254-313-4531

Provider Business Practice Location Address
First Line	:	3400 BELLMEAD DRIVE
Second Line	:
City	:	BELLMEAD
State	:	TX
Zip	:	76705
Country	:	US
Telephone Number	:	254-313-5400
Fax Number	:	254-313-4531

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	04/30/2013

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