Healthcare Provider Details

I. General information

NPI: 1710970710
Provider Name (Legal Business Name): RAUL ERNESTO AYALA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 JAMES L REDMAN PKWY
PLANT CITY FL
33566-7103
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 813-896-0750
  • Fax: 813-896-0753
Mailing address:
  • Phone: 727-322-3439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME79510
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: