Provider Demographics
NPI:1558323865
Name:RAIDER, ANDREW LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LEE
Last Name:RAIDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 SAINT DAVID ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-8146
Mailing Address - Country:US
Mailing Address - Phone:941-639-7743
Mailing Address - Fax:
Practice Address - Street 1:13681 DOCTORS WAY
Practice Address - Street 2:GULF COAST MEDICAL CENTER
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-3391
Practice Address - Country:US
Practice Address - Phone:239-343-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8882207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267425400Medicaid
FL71114OtherBLUECROSS
FL71114OtherBLUECROSS
FLH91380Medicare UPIN