Provider Demographics
NPI:1366404923
Name:PIGEON, RAYMOND GERALD (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:GERALD
Last Name:PIGEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5616
Mailing Address - Country:US
Mailing Address - Phone:619-297-3737
Mailing Address - Fax:619-297-0443
Practice Address - Street 1:3260 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5616
Practice Address - Country:US
Practice Address - Phone:619-297-3737
Practice Address - Fax:619-297-0443
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A622570Medicaid
CAG71627Medicare UPIN
CAWA62257CMedicare UPIN
CA00A622570Medicaid
WA62257CMedicare PIN