Provider Demographics
NPI:1467435867
Name:RAJU, SRINIVAS (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:
Last Name:RAJU
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 1:4790 BARKLEY CIR
Mailing Address - Street 2:BLDG A
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7543
Mailing Address - Country:US
Mailing Address - Phone:239-275-8882
Mailing Address - Fax:239-939-1330
Practice Address - Street 1:4790 BARKLEY CIR
Practice Address - Street 2:BLDG A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7543
Practice Address - Country:US
Practice Address - Phone:239-275-8882
Practice Address - Fax:239-939-1330
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88683207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2499135OtherGHI
FL81971OtherBCBS
FL292148OtherAVMED
FL9738143OtherCIGNA
FL226912OtherSTAYWELL
FLP00065871OtherRAILROAD MEDICARE
FL1467435867OtherTRICARE
FL2355139OtherUNITED HEALTHCARE
FL3382646OtherAETNA
FL268296600Medicaid
FL81971ZMedicare ID - Type Unspecified
FL268296600Medicaid