Provider Demographics
NPI:1063498384
Name:PRIETO, ENIO LUIS (MD)
Entity Type:Individual
Prefix:
First Name:ENIO
Middle Name:LUIS
Last Name:PRIETO
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 1:13846 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3231
Mailing Address - Country:US
Mailing Address - Phone:772-581-1881
Mailing Address - Fax:772-581-1885
Practice Address - Street 1:13846 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3231
Practice Address - Country:US
Practice Address - Phone:772-581-1881
Practice Address - Fax:772-581-1885
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258873100Medicaid
FLP00065585OtherRAILROAD MEDICARE
FL216600OtherWELLCARE
FL2444663OtherAETNA
FL35403OtherBLUE CROSS BLUE SHIELD
FL5735911001OtherCIGNA
FL7936152OtherAETNA
FLP00065585OtherRAILROAD MEDICARE
FLH16448Medicare UPIN