Provider Demographics
NPI:1982649968
Name:FLUKE, RAYMOND W (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:W
Last Name:FLUKE
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 1:25 FIRST PARK DR
Mailing Address - Street 2:STE A
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-5369
Mailing Address - Country:US
Mailing Address - Phone:207-873-4325
Mailing Address - Fax:207-873-4344
Practice Address - Street 1:30 CHASE AVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4624
Practice Address - Country:US
Practice Address - Phone:207-872-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME201770099Medicaid
ME201770099Medicaid
MEMM908101Medicare PIN
MEMM9081Medicare ID - Type Unspecified