Provider Demographics
NPI:1285613216
Name:BAKOTIC, RAYMOND PETER (DO)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:PETER
Last Name:BAKOTIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1925 W ORANGE GROVE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1143
Mailing Address - Country:US
Mailing Address - Phone:520-469-7351
Mailing Address - Fax:520-469-7355
Practice Address - Street 1:1925 W ORANGE GROVE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1143
Practice Address - Country:US
Practice Address - Phone:520-469-7351
Practice Address - Fax:520-469-7355
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ117223Medicare PIN