Provider Demographics
NPI:1851345771
Name:RAYMOND E PETERS INC
Entity Type:Organization
Organization Name:RAYMOND E PETERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-254-1648
Mailing Address - Street 1:9240 BONITA BEACH RD SE STE 2206
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4251
Mailing Address - Country:US
Mailing Address - Phone:239-821-8486
Mailing Address - Fax:239-254-1576
Practice Address - Street 1:9240 BONITA BEACH RD SE STE 2206
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4251
Practice Address - Country:US
Practice Address - Phone:239-821-8486
Practice Address - Fax:239-766-7528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7639438OtherAETNA
FL1851345771OtherNPI
FLM2606OtherBCBSFL