MEDICARE: DR. RAYMOND L RAITZ 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	207Q00000X	Family Medicine Physician	ME27197	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	LC416	OTHER	FL	MEDICARE
5	P01096253	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	78529	OTHER	FL	BLUE CROSS BLUE SHIELD
3	14Z2H	OTHER	FL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	01-07497	OTHER	FL	UNITED HEALTH CARE
7	68130	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1558368423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND L RAITZ M.D.

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2612

Provider Business Practice Location Address
First Line	:	506 4TH AVE W
Second Line	:
City	:	PALMETTO
State	:	FL
Zip	:	34221-5203
Country	:	US
Telephone Number	:	941-933-8108
Fax Number	:	941-933-8109

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

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	08/27/2020

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