1285613216 NPI number — DR. RAYMOND PETER BAKOTIC D.O.

Table of content: DR. RAYMOND PETER BAKOTIC D.O. (NPI 1285613216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285613216 NPI number — DR. RAYMOND PETER BAKOTIC D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKOTIC
Provider First Name:
RAYMOND
Provider Middle Name:
PETER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285613216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1925 W ORANGE GROVE RD
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85704-1143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-469-7351
Provider Business Mailing Address Fax Number:
520-469-7355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 W ORANGE GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85704-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-469-7351
Provider Business Practice Location Address Fax Number:
520-469-7355
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2712 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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