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NPI Code Detail

MEDICARE: DR. RAYMOND E DE LA ROSA M.D.

MEDICARE: DR. RAYMOND E DE LA ROSA M.D.
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
1207RE0101XEndocrinology, Diabetes & Metabolism PhysicianEMC0009215MI
2207RE0101XEndocrinology, Diabetes & Metabolism PhysicianME132402FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
130918OTHERKYSTATE LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083667984
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAYMOND E DE LA ROSA M.D.
Provider Business Mailing Address
First Line : 2675 WINKLER AVE FL 2
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-9342
Country : US
Telephone Number : 877-856-3774
Fax Number :
Provider Business Practice Location Address
First Line : 8383 S TAMIAMI TRL UNIT 115
Second Line :
City : SARASOTA
State : FL
Zip : 34238-2901
Country : US
Telephone Number : 941-841-4206
Fax Number : 941-841-4209
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2006
Last Update Date : 05/07/2026

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