Provider Demographics
NPI:1437292208
Name:TANO, RAUL IGNACIO (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:IGNACIO
Last Name:TANO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:11200 SW 8TH ST
Mailing Address - Street 2:AHC 2, 693
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33199-2516
Mailing Address - Country:US
Mailing Address - Phone:305-348-3627
Mailing Address - Fax:305-348-4261
Practice Address - Street 1:885 SW 109 AVE
Practice Address - Street 2:ROOM 131
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33199-0001
Practice Address - Country:US
Practice Address - Phone:305-348-3627
Practice Address - Fax:305-348-4261
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2012-07-18
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Provider Licenses
StateLicense IDTaxonomies
FLME46299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271280600Medicaid
FLD64705Medicare UPIN
FL271280600Medicaid