MEDICARE: SRINIVAS RAJU 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	207RG0100X	Gastroenterology Physician	ME88683	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00065871	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2499135	OTHER	FL	GHI
2	81971	OTHER	FL	BCBS
3	292148	OTHER	FL	AVMED
4	9738143	OTHER	FL	CIGNA
5	226912	OTHER	FL	STAYWELL
7	1467435867	OTHER	FL	TRICARE
8	2355139	OTHER	FL	UNITED HEALTHCARE
9	3382646	OTHER	FL	AETNA
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467435867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRINIVAS RAJU M.D.

Provider Business Mailing Address
First Line	:	4790 BARKLEY CIR
Second Line	:	BLDG A
City	:	FT MYERS
State	:	FL
Zip	:	33907-7543
Country	:	US
Telephone Number	:	239-275-8882
Fax Number	:	239-939-1330

Provider Business Practice Location Address
First Line	:	4790 BARKLEY CIR
Second Line	:	BLDG A
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7543
Country	:	US
Telephone Number	:	239-275-8882
Fax Number	:	239-939-1330

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	11/27/2023

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