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General NPI Number Information
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NPI Number | 1164643789
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Entity Type | Individual
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Provider Name | KEVIN KYLE RAYMER MD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 126 E MAIN ST STE B
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City | PAYSON
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State | AZ
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Zip | 85541-5488
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Country | US
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Telephone | 928-472-4675
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Fax | 928-472-3431
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Provider Business Mailing Address
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Address Line | PO BOX 859
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City | PAYSON
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State | AZ
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Zip | 85547-0859
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Country | US
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Telephone | 928-472-4675
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Fax | 928-472-3431
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04-32629
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 44721
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License Number State | AZ
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