Provider Demographics
NPI:1336171958
Name:RAJU, BHUPATIRAJU RAMA (MD)
Entity Type:Individual
Prefix:
First Name:BHUPATIRAJU
Middle Name:RAMA
Last Name:RAJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:STE 305
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:750 DESOTO AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2814
Practice Address - Country:US
Practice Address - Phone:352-796-6721
Practice Address - Fax:352-754-0375
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0021368207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL189163OtherSTAYWELL AND WELLCARE
FLP11197684OtherMULTIPLAN
FL5473411OtherFIRST HEALTH
FL054390000Medicaid
FLP00013910OtherRAIL ROAD MEDICARE
FL201943OtherAV MED
FL26022OtherBLUE CROSS BLUE SHIELD
FLP00984625OtherRR MCR
FL1551518OtherGHI
FL008054600Medicaid
FL4595765OtherAETNA
FLP00984625OtherRR MCR