Provider Demographics
NPI:1699766626
Name:ROJAS, EDGAR GRACIANO (MD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:GRACIANO
Last Name:ROJAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:36203 LAKE UNITY NURSERY RD
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-5818
Mailing Address - Country:US
Mailing Address - Phone:352-753-5222
Mailing Address - Fax:352-753-6483
Practice Address - Street 1:309 LAGRANDE BLVD
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-2386
Practice Address - Country:US
Practice Address - Phone:352-750-1999
Practice Address - Fax:352-750-1998
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME61133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB87526Medicare UPIN
FL26768YMedicare ID - Type Unspecified