Provider Demographics
NPI:1265413413
Name:RAUM, MARY ELWYN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELWYN
Last Name:RAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SW 12TH ST STE C202
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6521
Mailing Address - Country:US
Mailing Address - Phone:352-351-5640
Mailing Address - Fax:352-351-2967
Practice Address - Street 1:40 SW 12TH ST
Practice Address - Street 2:C202
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6525
Practice Address - Country:US
Practice Address - Phone:352-351-5640
Practice Address - Fax:352-351-2967
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036829207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCW237AMedicare PIN
FLD58916Medicare UPIN
1760710644Medicare PIN
FL79773ZMedicare PIN
FL79773Medicare ID - Type UnspecifiedMEDICARE