Provider Demographics
NPI:1558368423
Name:RAITZ, RAYMOND L (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:L
Last Name:RAITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:506 4TH AVE W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5203
Practice Address - Country:US
Practice Address - Phone:941-933-8108
Practice Address - Fax:941-933-8109
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME27197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78529OtherBLUE CROSS BLUE SHIELD
FLLC416OtherMEDICARE
FL14Z2HOtherBCBS
FL038670700Medicaid
FLP01096253OtherRAILROAD MEDICARE
FL01-07497OtherUNITED HEALTH CARE
FL68130OtherAETNA
FLD86291Medicare UPIN
FL038670700Medicaid
FL00653OtherUNIVERSAL HEALTH CARE