Provider Demographics
NPI:1467535112
Name:VILA, RAUL IVAN (MD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:IVAN
Last Name:VILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3450 BUSCHWOOD PARK DR STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4465
Mailing Address - Country:US
Mailing Address - Phone:813-935-8501
Mailing Address - Fax:813-935-8541
Practice Address - Street 1:2500 SW 75TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2805
Practice Address - Country:US
Practice Address - Phone:305-264-5252
Practice Address - Fax:305-266-1290
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0049181207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG09217Medicare UPIN