Basic Information
| Provider Information | |||||||||
| NPI: | 1053356964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTUCCI | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2160 COLONIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317212 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Practice Location | |||||||||
| Address1: | 7335 GLADIOLUS DR | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339085101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399851925 | ||||||||
| FaxNumber: | 2393216044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 01/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | ME 99967 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | ME 99967 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RC0200X | ME 99967 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7544875 | 01 | FL | AETNA | OTHER | 11336 | 01 | FL | BCBS OF FL | OTHER | 280282100 | 05 | FL | MEDICAID | 990635 | 01 | FL | WELLCARE | OTHER | 9455421 | 01 | FL | CIGNA | OTHER | P203272 | 01 | FL | OPTIMUM | OTHER | 2613158 | 05 | OH | MEDICAID | 313574 | 01 | FL | AVMED | OTHER | P305702 | 01 | FL | FREEDOM | OTHER | P01319839 | 01 | FL | RR MEDICARE | OTHER |