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General NPI Number Information
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NPI Number | 1417955840
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Entity Type | Individual
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Provider Name | RAUL A CORREA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2505 MANATEE AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-4935
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Country | US
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Telephone | 941-748-1171
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Fax | 941-748-4531
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Provider Business Mailing Address
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Address Line | 4004 BAYSIDE DR
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City | BRADENTON
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State | FL
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Zip | 34210-4113
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Country | US
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Telephone | 941-755-3300
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Fax | 941-751-3809
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | ME0026868
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License Number State | FL
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