MEDICARE: DR. DARIO AQUILES GRISALES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	ME79046	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00246786	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	03185	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407839806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARIO AQUILES GRISALES M.D.

Provider Business Mailing Address
First Line	:	16542 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1325
Country	:	US
Telephone Number	:	813-908-7868
Fax Number	:	813-908-8091

Provider Business Practice Location Address
First Line	:	16542 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1325
Country	:	US
Telephone Number	:	813-908-7868
Fax Number	:	813-908-8091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	05/06/2011

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