Provider Demographics
NPI:1588690978
Name:GRACIA, ROLAND MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:MANUEL
Last Name:GRACIA
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 1:1111 CRANDON BLVD
Mailing Address - Street 2:A1004
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-2745
Mailing Address - Country:US
Mailing Address - Phone:305-562-2150
Mailing Address - Fax:
Practice Address - Street 1:1111 CRANDON BLVD
Practice Address - Street 2:A1004
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-2745
Practice Address - Country:US
Practice Address - Phone:305-562-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME340752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261140600Medicaid
FL95772Medicare ID - Type Unspecified
FLD78939Medicare UPIN