Provider Demographics
NPI:1104806892
Name:PUMAREJO, RAYMOND MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:MANUEL
Last Name:PUMAREJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 NORTH LEE STREET, SUITE 203
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204
Mailing Address - Country:US
Mailing Address - Phone:904-354-8200
Mailing Address - Fax:904-354-1340
Practice Address - Street 1:425 N. LEE ST, # 203
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1128
Practice Address - Country:US
Practice Address - Phone:904-354-8200
Practice Address - Fax:904-354-1340
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 75751207RP1001X
FLME75751207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine