MEDICARE: RAUL F NODAL MDPA

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	261Q00000X	Clinic/Center	ME82531	FL

General Provider Information

NPI Number	:	1790719961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAUL F NODAL MDPA

Provider Business Mailing Address
First Line	:	11803 NICKLAUS CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-4539
Country	:	US
Telephone Number	:	813-368-2160
Fax Number	:	813-269-4109

Provider Business Practice Location Address
First Line	:	5012 GUNN HWY.
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624
Country	:	US
Telephone Number	:	813-960-2142
Fax Number	:	813-269-4109

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAUL F NODAL
Credential	:	M.D.
Telephone Number	:	813-960-2142

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/22/2020

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