Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | ME36832 | FL |
Y | 207RX0202X | Medical Oncology | ME36832 | FL |
NPI | 1184607624 |
---|---|
Provider Name | Dr. Michael G. Raymond |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Cape Coral, FL 33909-6529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041694100 | (05) | FL |
830004834 | RR MEDICARE (01) | FL |
D58988 | (02) | FL |