Raymond Jack Middleton, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

161827-1205 Issued in UT

Practice address

653 South 170 West
Ivins, UT 84738

Phone

(435) 632-8628

Fax

(435) 634-1320

NPI assigned

Apr 25, 2006

Last updated

Dec 22, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Snow Canyon Clinic, Inc.

  • Multi-Specialty Clinic/Center
  • Ivins, UT
  • NPI 1235185646
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482364800000",
    "number": "1083670459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "653 SOUTH 170 WEST",
            "city": "IVINS",
            "state": "UT",
            "postal_code": "84738",
            "telephone_number": "435-632-8628",
            "fax_number": "435-634-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653 SOUTH 170 WEST",
            "city": "IVINS",
            "state": "UT",
            "postal_code": "84738",
            "telephone_number": "435-632-8628",
            "fax_number": "435-634-1320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIDDLETON",
        "first_name": "RAYMOND",
        "middle_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2016-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "161827-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870609622001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05805",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Philip Lamoreaux
• Steven Raymond Leydsman
• Antonella Lozano, DO
• Raymond R. McPeek, M.D.
• Metwest Inc (DBA Quest Diagnostics Incorporated)
• Avery Monson, PTA
• Scott Robert Moore, L.M.T.
• Ahlai Narcisse
• Cole Newton
• Paiute Indian Tribe of Utah (Shivwits Medical Clinic)

• Family Medicine Physician in Ivins, UT
• Providers in Ivins, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.