MEDICARE: DR. ANDREW LEE RAIDER D.O.

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	207L00000X	Anesthesiology Physician	OS8882	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
2	71114	OTHER	FL	BLUECROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558323865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW LEE RAIDER D.O.

Provider Business Mailing Address
First Line	:	2332 SAINT DAVID ISLAND CT
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-8146
Country	:	US
Telephone Number	:	941-639-7743
Fax Number	:

Provider Business Practice Location Address
First Line	:	13681 DOCTORS WAY
Second Line	:	GULF COAST MEDICAL CENTER
City	:	FORT MYERS
State	:	FL
Zip	:	33912-3391
Country	:	US
Telephone Number	:	239-343-1000
Fax Number	:

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	01/13/2023

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