MEDICARE: RAUL AYALA INTERNAL MEDICINE LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194957977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAUL AYALA INTERNAL MEDICINE LLC

Provider Business Mailing Address
First Line	:	13150 VAIL RIDGE DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7187
Country	:	US
Telephone Number	:	813-677-2393
Fax Number	:	813-677-2347

Provider Business Practice Location Address
First Line	:	13150 VAIL RIDGE DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7187
Country	:	US
Telephone Number	:	813-677-2393
Fax Number	:	813-677-2347

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MR. RAUL E AYALA
Credential	:	MD
Telephone Number	:	813-677-2393

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	08/23/2011

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