Individual
RAYMOND LILLY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 N GRAND AVE, STE 508, PUEBLO, CO 81003-2757
(719) 595-7040
(719) 595-7045
Mailing address
1600 N GRAND AVE, STE 508, PUEBLO, CO 81003-2757
(719) 595-7040
(719) 595-7045
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
31336
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01313360
—
CO
01
—
P00149591
RAILROAD MEDICARE
CO
Enumeration date
07/07/2005
Last updated
10/12/2012
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