Provider Demographics
NPI:1831538800
Name:MAILHOT, RAYMOND BERNARD (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:BERNARD
Last Name:MAILHOT
Suffix:
Gender:M
Credentials:MD, MPH
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:PO BOX 116304
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6304
Mailing Address - Country:US
Mailing Address - Phone:908-588-1800
Mailing Address - Fax:904-588-1300
Practice Address - Street 1:2015 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206
Practice Address - Country:US
Practice Address - Phone:904-588-1800
Practice Address - Fax:904-588-1300
Is Sole Proprietor?:No
Enumeration Date:2013-06-22
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1360712085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME136071OtherSTATE MEDICAL LICENSE