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General NPI Number Information
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NPI Number | 1508817719
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Entity Type | Individual
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Provider Name | RAYMOND VALDES M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 208 SHOPPINGWAY BLVD SUITE A
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-1734
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Country | US
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Telephone | 870-733-1280
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Fax | 870-733-9443
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Provider Business Mailing Address
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Address Line | 208 SHOPPINGWAY BLVD STE A SUITE A
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-1734
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Country | US
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Telephone | 870-733-1280
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Fax | 877-441-0008
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD0000034563
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0E2536
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License Number State | AR
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