Provider Demographics
NPI:1013915636
Name:BRITO, ROGELIO A (DO)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:A
Last Name:BRITO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2623 S SEACREST BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7501
Practice Address - Country:US
Practice Address - Phone:561-742-0065
Practice Address - Fax:561-742-0105
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006649207RH0003X
FLOS6649207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01594398OtherRR MEDICARE
FL6648362OtherCIGNA
FLP971525OtherOPTIMUM
FLP995707OtherFREEDOM
FL14390OtherDIMENSION
FL260470OtherAVMED
FL5957667OtherAETNA
FL80895OtherBCBS
FLF81470Medicare UPIN
FL80895OtherBCBS
FL80895XMedicare PIN