Provider Demographics
NPI:1669435772
Name:RAQUET, ROBERT A (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:RAQUET
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 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:352-674-8919
Practice Address - Street 1:2485 PINELLAS PL
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2703
Practice Address - Country:US
Practice Address - Phone:352-674-1720
Practice Address - Fax:352-674-8920
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067664L207R00000X
FLME126725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME126725OtherMEDICAL LICENSE
PA02248202OtherCAPITAL BLUE CROSS
PA50379OtherGEISINGER HEALTH PLAN
PA0017490040001Medicaid
PA110190183OtherRAILROAD MEDICARE
PARA996700OtherHIGHMARK BLUE SHIELD
PA02248202OtherCAPITAL BLUE CROSS
PAG46345Medicare UPIN