Provider Demographics
NPI:1376657528
Name:WATERS, RAYMOND S (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:S
Last Name:WATERS
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 1:223 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950
Mailing Address - Country:US
Mailing Address - Phone:941-639-6616
Mailing Address - Fax:941-639-1716
Practice Address - Street 1:223 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950
Practice Address - Country:US
Practice Address - Phone:941-639-6616
Practice Address - Fax:941-639-1716
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38648208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47422OtherBCBS
FLC78519Medicare UPIN
FL47422AMedicare ID - Type Unspecified