Provider Demographics
NPI:1386012896
Name:RAJ, ANIL KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:KUMAR
Last Name:RAJ
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 1:40 S ALCANIZ ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-6008
Mailing Address - Country:US
Mailing Address - Phone:850-202-4456
Mailing Address - Fax:850-202-4440
Practice Address - Street 1:40 S ALCANIZ ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6008
Practice Address - Country:US
Practice Address - Phone:850-202-4456
Practice Address - Fax:850-202-4440
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5871208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice