Provider Demographics
NPI:1407884018
Name:RAIME, MARIE (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:RAIME
Suffix:
Gender:F
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:PO BOX 3412
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-3412
Mailing Address - Country:US
Mailing Address - Phone:386-754-0339
Mailing Address - Fax:386-754-0593
Practice Address - Street 1:1283 SW STATE ROAD 47
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-0489
Practice Address - Country:US
Practice Address - Phone:386-754-0339
Practice Address - Fax:306-754-0393
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009896400Medicaid
FLHO4412Medicare UPIN
FLE8755YMedicare PIN