Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 006918 | AZ |
NPI | 1427316470 |
---|---|
Provider Name | Dr. Justin Michael Raye |
First Address | Bradenton, FL 34209-3707 |
Second Address | Sarasota, FL 34239-2640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2012 |
Last Update Date | 27/09/2018 |