MEDICARE: RAYMOND J. ENZENAUER 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	207RR0500X	Rheumatology Physician	35274	TN

General Provider Information

NPI Number	:	1952322398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND J. ENZENAUER MD

Provider Business Mailing Address
First Line	:	1214 N CONCORD RD
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-3849
Country	:	US
Telephone Number	:	423-933-7704
Fax Number	:	423-778-3157

Provider Business Practice Location Address
First Line	:	2700 WESTSIDE DR NW
Second Line	:	SUITE 200
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3699
Country	:	US
Telephone Number	:	423-478-1050
Fax Number	:	423-479-9459

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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