Individual
DR. EDMUND WILLIAM RAYCRAFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
304 W HAY ST, SUITE 111, DECATUR, IL 62526-6328
(217) 872-8200
(217) 872-4898
Mailing address
304 W HAY ST, SUITE 111, DECATUR, IL 62526-6328
(217) 872-8200
(217) 872-4898
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036079689
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005832071
BLUE CROSS BLUE SHIELD
IL
05
—
036079689
—
IL
01
—
131595
HEALTHLINK
IL
01
—
5574560001
MEDICARE DME
IL
01
—
P00273351
RAILROAD MEDICARE
IL
Enumeration date
07/21/2005
Last updated
02/08/2010
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