Provider Demographics
NPI:1386884310
Name:GARY A RAYMOND DPM PC
Entity type:Organization
Organization Name:GARY A RAYMOND DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-943-3668
Mailing Address - Street 1:711 LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4165
Mailing Address - Country:US
Mailing Address - Phone:814-943-3668
Mailing Address - Fax:814-942-7635
Practice Address - Street 1:154 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686
Practice Address - Country:US
Practice Address - Phone:814-684-0410
Practice Address - Fax:814-942-7635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARY A RAYMOND DPM PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-04
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA599562Medicare PIN