Provider Demographics
NPI:1265413801
Name:CAPARROS, RAYMUNDO IDEA (MD)
Entity type:Individual
Prefix:
First Name:RAYMUNDO
Middle Name:IDEA
Last Name:CAPARROS
Suffix:
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:239-343-0550
Mailing Address - Fax:239-343-4013
Practice Address - Street 1:13340 METRO PKWY STE 400
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4818
Practice Address - Country:US
Practice Address - Phone:239-343-0550
Practice Address - Fax:239-343-4013
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41284207RC0200X, 207RP1001X
FLME115944207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACE8614 290009337OtherRAILROAD MEDICARE
MDKA95MA 52562003OtherCAREFIRST
FL0141244500Medicaid
DC3340 0002OtherCAREFIRST
MD462971000 646931100Medicaid
DC3340 0002OtherCAREFIRST