MEDICARE: DR. RAYMOND A MOCKLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician	ME67903	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	593647683	OTHER	FL	TAX ID
2	27145	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1053499624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND A MOCKLER M.D.

Provider Business Mailing Address
First Line	:	500 AIRPORT RD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4011
Country	:	US
Telephone Number	:	850-769-7270
Fax Number	:	850-769-7229

Provider Business Practice Location Address
First Line	:	500 AIRPORT RD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4011
Country	:	US
Telephone Number	:	850-769-7270
Fax Number	:	850-769-7229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/13/2025

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