Provider Demographics
NPI:1972597185
Name:ANDREASSEN, RAYMOND EDGAR (DO)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:EDGAR
Last Name:ANDREASSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 60 BOX 4860
Mailing Address - Street 2:
Mailing Address - City:DELTA JUNCTION
Mailing Address - State:AK
Mailing Address - Zip Code:99737-9440
Mailing Address - Country:US
Mailing Address - Phone:907-895-5100
Mailing Address - Fax:907-895-5133
Practice Address - Street 1:HC 60 BOX 4860
Practice Address - Street 2:
Practice Address - City:DELTA JUNCTION
Practice Address - State:AK
Practice Address - Zip Code:99737-9440
Practice Address - Country:US
Practice Address - Phone:907-895-5100
Practice Address - Fax:907-895-5133
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA2011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD9969Medicaid
AKMD9969Medicaid
08WCKHQARMedicare ID - Type Unspecified