Provider Demographics
NPI:1578551321
Name:PRIETO, ROLANDO ERNESTO (MD)
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:ERNESTO
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:PO BOX 6200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-6200
Mailing Address - Country:US
Mailing Address - Phone:352-671-4300
Mailing Address - Fax:352-671-4393
Practice Address - Street 1:1818 SW 15TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3548
Practice Address - Country:US
Practice Address - Phone:352-671-4300
Practice Address - Fax:352-671-4393
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 679562085R0202X
FLME679562085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379489000Medicaid
FL379489000Medicaid
FL28445Medicare ID - Type Unspecified