Provider Demographics
NPI:1215966882
Name:LEVEILLEE, RAYMOND JOHN (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOHN
Last Name:LEVEILLEE
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 1:2800 S SEACREST BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7960
Mailing Address - Country:US
Mailing Address - Phone:561-734-2746
Mailing Address - Fax:561-734-4705
Practice Address - Street 1:2800 S SEACREST BLVD STE 140
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7943
Practice Address - Country:US
Practice Address - Phone:561-734-2746
Practice Address - Fax:561-734-4705
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71523208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3780988-00Medicaid
FL27550Medicare UPIN
FL3780988-00Medicaid