# RAIMAH PRIMARY CARE CENTER PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174719629
- **Authorized official:** DR. MARIE RAIME MD (DOCTOR)
- **Authorized official phone:** (386) 754-0339

## Contact information

- **Practice address:** 1283 SW STATE ROAD 47, 103, LAKE CITY, FL 32025-0489
- **Practice address phone:** (386) 754-0339
- **Practice address fax:** (386) 754-0393
- **Mailing address:** 1283 SW STATE ROAD 47, SUITE103, LAKE CITY, FL 32025-0489
- **Mailing address phone:** (386) 754-0339
- **Mailing address fax:** (386) 754-0393

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | ME85010 | FL | Yes |

## Other

- **Enumeration date:** 09/19/2007
- **Last updated:** 12/11/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 264300600 | — | FL |