Provider Demographics
NPI:1841264595
Name:FRAILE, ROBERTO J (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:J
Last Name:FRAILE
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 1:212 LAKE REGION BLVD S
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-9566
Mailing Address - Country:US
Mailing Address - Phone:863-324-9631
Mailing Address - Fax:
Practice Address - Street 1:212 LAKE REGION BLVD SOUTH
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-9566
Practice Address - Country:US
Practice Address - Phone:863-324-9631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37101207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0397229-00Medicaid
FL0397229-00Medicaid
FLD86015Medicare UPIN