Individual
RAYMOND VETSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1102 W 32ND STREET, STE 200, JOPLIN, MO 64804
(417) 782-3000
(417) 782-3088
Mailing address
PO BOX 3810, JOPLIN, MO 64803
(417) 782-3000
(417) 782-3088
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
114480
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100063690A
—
OK
05
—
100313740A
—
KS
01
—
113224
ANTHEM
MO
05
—
208522219
—
MO
01
—
330004680
RR MEDICARE
—
Enumeration date
06/17/2006
Last updated
03/05/2012
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