Provider Demographics
NPI:1366517609
Name:ALONGE, RAYMOND FRANK JR (CRNA)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:FRANK
Last Name:ALONGE
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5933 RILEY RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6889
Mailing Address - Country:US
Mailing Address - Phone:423-838-0783
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:2341 MCCALLIE AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-326-1391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN118584367500000X
NC5694225367500000X
GARN193541367500000X
KY5360A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74007433600Medicaid
NC8052921Medicaid
NC2619686Medicare PIN
TN3631144Medicare PIN