Healthcare Provider Details

I. General information

NPI: 1225327554
Provider Name (Legal Business Name): DR. DANIEL ROURA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 BRUCE B DOWNS BLVD # 41
TAMPA FL
33612-4742
US

IV. Provider business mailing address

517 COLUMBIA DR APT 22
TAMPA FL
33606-3933
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-3680
  • Fax: 813-974-8359
Mailing address:
  • Phone: 904-699-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number52066
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: