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NPI Code Detail

MEDICARE: RAYMOND P MOONEY P.A.-C.

MEDICARE: RAYMOND P MOONEY P.A.-C.
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
1363A00000XPhysician Assistant5601001087MI

General Provider Information

NPI Number : 1770504102
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAYMOND P MOONEY P.A.-C.
Provider Business Mailing Address
First Line : 107 CHICAGO ST
Second Line :
City : BROOKLYN
State : MI
Zip : 49230-9703
Country : US
Telephone Number : 517-592-3275
Fax Number : 517-592-2540
Provider Business Practice Location Address
First Line : 107 CHICAGO ST
Second Line :
City : BROOKLYN
State : MI
Zip : 49230-9703
Country : US
Telephone Number : 517-592-3275
Fax Number : 517-592-2540
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 07/08/2007

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Directions to “ RAYMOND P MOONEY P.A.-C.” Practice Location

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