Provider Demographics
NPI:1114982014
Name:DAVE, RAJESH B (MD)
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:B
Last Name:DAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1224
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34673-1224
Mailing Address - Country:US
Mailing Address - Phone:727-848-0247
Mailing Address - Fax:727-841-6351
Practice Address - Street 1:6424 EMBASSY BLVD STE A
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4980
Practice Address - Country:US
Practice Address - Phone:727-848-0247
Practice Address - Fax:727-841-6351
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME63067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF56170OtherRAILROAD MEDICARE
FL141912250OtherHUMANA
FL18665OtherBLUECROSS AND BLUE SHIELD
FL488251OtherAETNA
FL371899900Medicaid
FL00-05747OtherUNITED
FL7073332OtherCIGNA
FL141912250OtherHUMANA
FLF56170Medicare UPIN
FL141912250OtherHUMANA