Healthcare Provider Details

I. General information

NPI: 1760771828
Provider Name (Legal Business Name): RAYMOND DERWIN JONES CFTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3243 US HIGHWAY 70 E STE 202
SMITHFIELD NC
27577-8794
US

IV. Provider business mailing address

3243 US HIGHWAY 70 E STE 202
SMITHFIELD NC
27577-8794
US

V. Phone/Fax

Practice location:
  • Phone: 855-965-6900
  • Fax: 919-965-6902
Mailing address:
  • Phone: 855-965-6900
  • Fax: 919-965-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCFTS01245
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: