Healthcare Provider Details

I. General information

NPI: 1760475206
Provider Name (Legal Business Name): RAYMOND M. PAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2857 JUNIPER DR
LEWISTON ID
83501-4719
US

IV. Provider business mailing address

213 N MAIN
MOSCOW ID
83843
US

V. Phone/Fax

Practice location:
  • Phone: 208-848-8499
  • Fax:
Mailing address:
  • Phone: 208-882-7565
  • Fax: 208-882-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM9266
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: