MEDICARE: MR. ROBERSON RAYMOND R.T., R.D.M.S.

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	2471C3402X	Radiography Radiologic Technologist	CRT 33569	FL
2	2471S1302X	Sonography Radiologic Technologist	37218	FL

General Provider Information

NPI Number	:	1174842678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERSON RAYMOND R.T., R.D.M.S.

Provider Business Mailing Address
First Line	:	4123 ARTHURIUM AVE
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-3431
Country	:	US
Telephone Number	:	561-503-6331
Fax Number	:

Provider Business Practice Location Address
First Line	:	4123 ARTHURIUM AVE
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-3431
Country	:	US
Telephone Number	:	561-503-6331
Fax Number	:

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

Provider Enumeration Date	:	05/24/2010
Last Update Date	:	05/24/2010

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