Provider Demographics
NPI:1578565362
Name:PRIEWE, RAYMON DEAN (DO)
Entity Type:Individual
Prefix:
First Name:RAYMON
Middle Name:DEAN
Last Name:PRIEWE
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 1:6815 14TH ST W
Mailing Address - Street 2:SUITE204
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-5810
Mailing Address - Country:US
Mailing Address - Phone:941-758-7300
Mailing Address - Fax:941-758-7334
Practice Address - Street 1:6815 14TH ST W
Practice Address - Street 2:SUITE204
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-5810
Practice Address - Country:US
Practice Address - Phone:941-758-7300
Practice Address - Fax:941-758-7334
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5370207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6408040001OtherPTAN
FL1629020508OtherNPI GROUP #
FL6408040001Medicare NSC