Provider Demographics
NPI:1184771669
Name:PETRUS, RAYMOND ANTHONY II (DO)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ANTHONY
Last Name:PETRUS
Suffix:II
Gender:M
Credentials:DO
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Mailing Address - Street 1:13860 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2420
Mailing Address - Country:US
Mailing Address - Phone:813-844-4500
Mailing Address - Fax:813-844-1950
Practice Address - Street 1:13860 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2420
Practice Address - Country:US
Practice Address - Phone:813-844-4500
Practice Address - Fax:813-844-1950
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS6910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG37154Medicare UPIN