MEDICARE: JON F RAYMOND 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	207Q00000X	Family Medicine Physician	5992	ND

General Provider Information

NPI Number	:	1508958935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON F RAYMOND MD

Provider Business Mailing Address
First Line	:	2401 DEMERS AVE
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-4183
Country	:	US
Telephone Number	:	701-780-1891
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 S WASHINGTON ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-7245
Country	:	US
Telephone Number	:	701-732-7000
Fax Number	:

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

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	06/15/2021

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