MEDICARE: PAUL M ROUGRAFF MD

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	207W00000X	Ophthalmology Physician	ME63864	FL
2	207W00000X	Ophthalmology Physician	01041604A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27485	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1831176288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL M ROUGRAFF MD

Provider Business Mailing Address
First Line	:	661 GOODLETTE RD N
Second Line	:	SUITE 105
City	:	NAPLES
State	:	FL
Zip	:	34102-5609
Country	:	US
Telephone Number	:	239-262-6288
Fax Number	:	239-262-5434

Provider Business Practice Location Address
First Line	:	661 GOODLETTE RD N
Second Line	:	SUITE 105
City	:	NAPLES
State	:	FL
Zip	:	34102-5609
Country	:	US
Telephone Number	:	239-262-6288
Fax Number	:	239-262-5434

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	05/27/2009

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Directions to “ PAUL M ROUGRAFF MD” Practice Location

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