Provider Demographics
NPI:1609869155
Name:DEMORAES, ROMEL TAVARES (MD PA)
Entity Type:Individual
Prefix:MR
First Name:ROMEL
Middle Name:TAVARES
Last Name:DEMORAES
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 PINELLAS ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3426
Mailing Address - Country:US
Mailing Address - Phone:727-441-8618
Mailing Address - Fax:727-443-4798
Practice Address - Street 1:715 PINELLAS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3426
Practice Address - Country:US
Practice Address - Phone:727-441-8618
Practice Address - Fax:727-443-4798
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30576208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0582740001OtherCIGNA
FL4409393OtherAETNA
FL4409393OtherAETNA
D53834Medicare UPIN