Provider Demographics
NPI:1699770016
Name:DEMOVILLE, RAYMOND B (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:B
Last Name:DEMOVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:1525 HUNT CLUB BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6070
Practice Address - Country:US
Practice Address - Phone:615-822-2177
Practice Address - Fax:615-822-0300
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000034182207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ030576Medicaid
TN6123764OtherBCBS
TN103I045255OtherMEDICARE