Provider Demographics
NPI:1972532968
Name:DAVILA, RAUL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:DAVID
Last Name:DAVILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAUL
Other - Middle Name:DAVID
Other - Last Name:DAVILA CORREA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8192 COLLEGE PKWY STE A18
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5198
Mailing Address - Country:US
Mailing Address - Phone:239-454-0418
Mailing Address - Fax:239-454-0419
Practice Address - Street 1:8192 COLLEGE PKWY STE A18
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5198
Practice Address - Country:US
Practice Address - Phone:239-454-0418
Practice Address - Fax:239-454-0419
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79321207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH 30764Medicare UPIN