Provider Demographics
NPI:1225914849
Name:GREY BEAR, RAYMOND VINCENT
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:VINCENT
Last Name:GREY BEAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 37TH AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5524
Mailing Address - Country:US
Mailing Address - Phone:701-471-7092
Mailing Address - Fax:701-401-0267
Practice Address - Street 1:1605 E CAPITOL AVE STE 100
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2102
Practice Address - Country:US
Practice Address - Phone:701-471-7092
Practice Address - Fax:701-401-0267
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator