Provider Demographics
NPI:1497776827
Name:XAVIER, RAVI (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:XAVIER
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:PO BOX 862622
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-2622
Mailing Address - Country:US
Mailing Address - Phone:561-578-8400
Mailing Address - Fax:561-578-8099
Practice Address - Street 1:2201 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4796
Practice Address - Country:US
Practice Address - Phone:772-489-0051
Practice Address - Fax:772-489-0026
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 61008207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056753100Medicaid
FL14228Medicare PIN
FL056753100Medicaid