MEDICARE: DR. RAYMOND MANUEL PUMAREJO 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	207RP1001X	Pulmonary Disease Physician	ME 75751	FL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	ME75751	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104806892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND MANUEL PUMAREJO M.D.

Provider Business Mailing Address
First Line	:	425 NORTH LEE STREET, SUITE 203
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204
Country	:	US
Telephone Number	:	904-354-8200
Fax Number	:	904-354-1340

Provider Business Practice Location Address
First Line	:	425 N. LEE ST, # 203
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-1128
Country	:	US
Telephone Number	:	904-354-8200
Fax Number	:	904-354-1340

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	02/10/2014

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Directions to “ DR. RAYMOND MANUEL PUMAREJO M.D.” Practice Location

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