Healthcare Provider Details

I. General information

NPI: 1235122698
Provider Name (Legal Business Name): RAYMOND LOUIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4347 PACHECO ST
SAN FRANCISCO CA
94116-1057
US

IV. Provider business mailing address

4347 PACHECO ST
SAN FRANCISCO CA
94116-1057
US

V. Phone/Fax

Practice location:
  • Phone: 408-438-7290
  • Fax:
Mailing address:
  • Phone: 408-438-7290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC39297
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC39397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: