Provider Demographics
NPI:1790744746
Name:RASKAUSKAS, PAUL A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:RASKAUSKAS
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 1:6901 INTERNATIONAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7125
Mailing Address - Country:US
Mailing Address - Phone:239-939-4323
Mailing Address - Fax:239-939-3983
Practice Address - Street 1:6901 INTERNATIONAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7125
Practice Address - Country:US
Practice Address - Phone:239-939-4323
Practice Address - Fax:239-939-3983
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060400207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL180022164OtherRAILROAD MEDICARE
FL054575900Medicaid
FL374440000Medicaid
FLCA7010OtherRAILROAD MEDICARE GROUP
FL054575900Medicaid
FLCA7010OtherRAILROAD MEDICARE GROUP
FLE92993Medicare UPIN
FL33090CMedicare PIN