Provider Demographics
NPI:1851313209
Name:DREW, RAYMOND LESTER (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LESTER
Last Name:DREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E 28TH ST
Mailing Address - Street 2:SUITE 480
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1139
Mailing Address - Country:US
Mailing Address - Phone:612-863-1580
Mailing Address - Fax:612-863-1585
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-7501
Practice Address - Fax:612-863-1585
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21101208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN995295100Medicaid
020000242Medicare ID - Type Unspecified
A93777Medicare UPIN