Provider Demographics
NPI:1215900998
Name:AYALA, RICARDO L (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:L
Last Name:AYALA
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:PO BOX 3130
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-3130
Mailing Address - Country:US
Mailing Address - Phone:352-867-8311
Mailing Address - Fax:352-622-5771
Practice Address - Street 1:524 SE OSCEOLA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2322
Practice Address - Country:US
Practice Address - Phone:772-419-2379
Practice Address - Fax:772-419-2377
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-11
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84426207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265387700Medicaid
H66790Medicare UPIN
FL13363Medicare PIN
FL13363VMedicare ID - Type Unspecified
FL265387700Medicaid