MEDICARE: ALEX RAYMOND

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	175T00000X	Peer Specialist	THW000003947	OR

General Provider Information

NPI Number	:	1568053536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX RAYMOND

Provider Business Mailing Address
First Line	:	PO BOX 16576
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97292-0576
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 MAIN ST STE 201
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-1834
Country	:	US
Telephone Number	:	503-465-2749
Fax Number	:

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

Provider Enumeration Date	:	02/01/2021
Last Update Date	:	02/01/2021

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Directions to “ ALEX RAYMOND ” Practice Location

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