Provider Demographics
NPI:1043323231
Name:HENRIQUES, R A (MD)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:A
Last Name:HENRIQUES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 DELANNOY AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7813
Mailing Address - Country:US
Mailing Address - Phone:321-631-6995
Mailing Address - Fax:321-633-1004
Practice Address - Street 1:503 DELANNOY AVE
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7813
Practice Address - Country:US
Practice Address - Phone:321-631-6995
Practice Address - Fax:321-633-1004
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME41259OtherSTATE LICENSE NUMBER
FLME41259OtherSTATE LICENSE NUMBER
FL05511Medicare ID - Type Unspecified