Provider Demographics
NPI:1851501704
Name:STOREY-ROJAS, RAUL ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:ENRIQUE
Last Name:STOREY-ROJAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:3730 7TH TERRACE
Practice Address - Street 2:STE 101
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6556
Practice Address - Country:US
Practice Address - Phone:772-581-0528
Practice Address - Fax:772-581-0535
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111907207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012746900Medicaid
FLGH490YMedicare PIN