Provider Demographics
NPI:1790936409
Name:ROSTORFER, REGAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:REGAN
Middle Name:D
Last Name:ROSTORFER
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 1:9900 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3448
Mailing Address - Country:US
Mailing Address - Phone:321-843-7440
Mailing Address - Fax:321-843-7497
Practice Address - Street 1:9900 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3448
Practice Address - Country:US
Practice Address - Phone:321-843-7440
Practice Address - Fax:321-843-7497
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105256207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004943400Medicaid
FLME105256OtherMEDICAL LICENSE
FLGE331ZMedicare PIN