Healthcare Provider Details

I. General information

NPI: 1306861489
Provider Name (Legal Business Name): RAJ K SAXENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E HIGHLAND AVE STE 1
CLERMONT FL
34711-2582
US

IV. Provider business mailing address

200 E HIGHLAND AVE STE 1
CLERMONT FL
34711-2582
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-3611
  • Fax: 352-394-0739
Mailing address:
  • Phone: 352-394-3611
  • Fax: 352-394-0739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0057361
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: