Provider Demographics
NPI:1053356964
Name:SANTUCCI, RAYMOND II (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:SANTUCCI
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-985-1925
Mailing Address - Fax:239-321-6044
Practice Address - Street 1:16420 HEALTHPARK COMMONS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9621
Practice Address - Country:US
Practice Address - Phone:239-985-1925
Practice Address - Fax:239-321-6044
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 99967207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11336OtherBCBS OF FL
OH2613158Medicaid
FLP203272OtherOPTIMUM
FL7544875OtherAETNA
FLP305702OtherFREEDOM
FL990635OtherWELLCARE
FLP01319839OtherRR MEDICARE
FL280282100Medicaid
FL313574OtherAVMED
FL9455421OtherCIGNA
FL280282100Medicaid
OH2613158Medicaid
FLAI312ZMedicare PIN