Provider Demographics
NPI:1770898124
Name:DEYNES-ROLDAN, LOIDA E (MD)
Entity type:Individual
Prefix:DR
First Name:LOIDA
Middle Name:E
Last Name:DEYNES-ROLDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 CORTARO DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6812
Mailing Address - Country:US
Mailing Address - Phone:787-235-9329
Mailing Address - Fax:813-634-3008
Practice Address - Street 1:787 CORTARO DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6812
Practice Address - Country:US
Practice Address - Phone:813-634-2500
Practice Address - Fax:813-634-3008
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20567207R00000X
FLME126149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME126149OtherMEDICAL LICENSE
FL016137800Medicaid
FLIJ658YOtherMEDICARE
FLIJ658YOtherMEDICARE
FLME126149OtherMEDICAL LICENSE
PRHR118AMedicare Oscar/Certification