Provider Demographics
NPI:1750357174
Name:RASCON-AGUILAR, IVAN ESTUARDO (MD)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:ESTUARDO
Last Name:RASCON-AGUILAR
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 1:1886 59TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4630
Mailing Address - Country:US
Mailing Address - Phone:941-794-1980
Mailing Address - Fax:941-794-2893
Practice Address - Street 1:1886 59TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4630
Practice Address - Country:US
Practice Address - Phone:941-794-1980
Practice Address - Fax:941-794-2893
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93817207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI45193Medicare UPIN
FL29345ZMedicare PIN