Provider Demographics
NPI:1831193770
Name:MACEIRA-RODRIGUEZ, LUIS RAUL (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAUL
Last Name:MACEIRA-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:RAUL
Other - Last Name:MACEIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2896 SUMMER SWAN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7404
Mailing Address - Country:US
Mailing Address - Phone:407-207-2146
Mailing Address - Fax:
Practice Address - Street 1:2896 SUMMER SWAN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7404
Practice Address - Country:US
Practice Address - Phone:407-207-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60036207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY370499899Medicaid
FL370499899Medicaid
FL12489OtherBCBS GROUP # 45262
FL12489OtherGROUP # 72076
FL12489OtherBCBS GROUP # 45262
FL12489FMedicare PIN
FL370499899Medicaid
FL12489EMedicare PIN