MEDICARE: DR. BRIAN PHILIP RAJCA 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
1	207R00000X	Internal Medicine Physician	ME 106197	FL
2	207RG0100X	Gastroenterology Physician	61620-20	WI

General Provider Information

NPI Number	:	1083876197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN PHILIP RAJCA M.D.

Provider Business Mailing Address
First Line	:	625 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-2667
Country	:	US
Telephone Number	:	239-772-3636
Fax Number	:	239-772-5073

Provider Business Practice Location Address
First Line	:	625 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-2667
Country	:	US
Telephone Number	:	239-772-3636
Fax Number	:	239-772-5073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	08/04/2016

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