Healthcare Provider Details

I. General information

NPI: 1417651902
Provider Name (Legal Business Name): ANNA MARIA RAYMOND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703
US

IV. Provider business mailing address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-4000
  • Fax:
Mailing address:
  • Phone: 907-361-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101283645
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: