Healthcare Provider Details

I. General information

NPI: 1245037928
Provider Name (Legal Business Name): STEVEN DOUGLAS RAYMOND JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 PIPER ST
ANCHORAGE AK
99508-4665
US

IV. Provider business mailing address

8428 METZGER AVE UNIT B
JBER AK
99506-2034
US

V. Phone/Fax

Practice location:
  • Phone: 830-370-0547
  • Fax:
Mailing address:
  • Phone: 830-370-0547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number865214
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number198483
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: