Provider Demographics
NPI:1659328003
Name:AREVALO ARAUJO, ROBERTO (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:AREVALO ARAUJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERTO
Other - Middle Name:A
Other - Last Name:ARAUJO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3000 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-2635
Mailing Address - Country:US
Mailing Address - Phone:727-849-6690
Mailing Address - Fax:727-848-3771
Practice Address - Street 1:3000 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-2635
Practice Address - Country:US
Practice Address - Phone:727-849-6690
Practice Address - Fax:727-848-3771
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36530207R00000X, 207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066339500Medicaid
110000344Medicare PIN
FL51134UMedicare PIN
FL066339500Medicaid
FL51134ZMedicare PIN
FL51134XMedicare PIN