Healthcare Provider Details

I. General information

NPI: 1235834359
Provider Name (Legal Business Name): PHILIP ANTHONY RAGUSA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POPE AVE NW STE 300
WINTER HAVEN FL
33881-4679
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 863-299-2636
  • Fax: 833-449-2410
Mailing address:
  • Phone: 321-635-2190
  • Fax: 689-304-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS22398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: