Healthcare Provider Details

I. General information

NPI: 1285793232
Provider Name (Legal Business Name): RAYMOND ALLEN JAMES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21298 OLEAN BLVD
PORT CHARLOTTE FL
33952-6705
US

IV. Provider business mailing address

3141 NW 63RD ST SUITE 4
OKLAHOMA CITY OK
73116-3788
US

V. Phone/Fax

Practice location:
  • Phone: 941-627-6130
  • Fax: 941-627-6146
Mailing address:
  • Phone: 405-607-1318
  • Fax: 405-607-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS7168
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: