MEDICARE: BENNY G RAIMER 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	208000000X	Pediatrics Physician	E2804	TX

General Provider Information

NPI Number	:	1699833178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENNY G RAIMER MD

Provider Business Mailing Address
First Line	:	301 UNIVERSITY BLVD
Second Line	:	6400 MEMORIAL DRIVE
City	:	GALVESTON
State	:	TX
Zip	:	77555-5302
Country	:	US
Telephone Number	:	409-772-0848
Fax Number	:	409-772-0885

Provider Business Practice Location Address
First Line	:	6400 MEMORIAL DR
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-4018
Country	:	US
Telephone Number	:	409-772-0848
Fax Number	:	409-772-0885

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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