MEDICARE: JOHN R RAYMOND SR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	18867	SC
2	207RN0300X	Nephrology Physician	61052	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043328099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN R RAYMOND SR. MD

Provider Business Mailing Address
First Line	:	8701 WATERTOWN PLANK ROAD
Second Line	:	OFFICE OF THE PRESIDENT
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-0509
Country	:	US
Telephone Number	:	414-955-8225
Fax Number	:	414-955-6560

Provider Business Practice Location Address
First Line	:	8701 WATERTOWN PLANK ROAD
Second Line	:	OFFICE OF THE PRESIDENT
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-0509
Country	:	US
Telephone Number	:	414-955-8225
Fax Number	:	414-955-6560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	11/15/2019

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