# DR. DANTULURI P RAJU

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1053316133
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | 34166 | FL | Yes |

## Other

- **Enumeration date:** 06/16/2005
- **Last updated:** 08/27/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000462200 | — | FL |
| 05 | — | 039223500 | — | FL |
| 01 | — | 42139 | BCBS | FL |
| 01 | — | JQ057 | MEDICARE | FL |