Provider Demographics
NPI:1598867434
Name:RALEY, JANE-MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JANE-MARIE
Middle Name:
Last Name:RALEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10055 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1902
Mailing Address - Country:US
Mailing Address - Phone:407-679-4800
Mailing Address - Fax:407-679-0574
Practice Address - Street 1:10055 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1902
Practice Address - Country:US
Practice Address - Phone:407-679-4800
Practice Address - Fax:407-679-0574
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80330YOtherMEDICARE
FL80330YOtherMEDICARE
FLE69956Medicare UPIN