Healthcare Provider Details

I. General information

NPI: 1972544435
Provider Name (Legal Business Name): ROBERT CRAIG RAYMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PROVIDENCE DR
NEWBERG OR
97132-7485
US

IV. Provider business mailing address

1001 PROVIDENCE DR
NEWBERG OR
97132-7485
US

V. Phone/Fax

Practice location:
  • Phone: 503-537-1785
  • Fax: 503-537-1809
Mailing address:
  • Phone: 503-537-1785
  • Fax: 503-537-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD24140
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: