Basic Information
Provider Information
NPI: 1811969520
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAWYER
FirstName: RAE
MiddleName: WORLEY
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6983 E FOWLER AVE
Address2:  
City: TAMPA
State: FL
PostalCode: 336171714
CountryCode: US
TelephoneNumber: 8138996226
FaxNumber: 8139858006
Practice Location
Address1: 3100 E FLETCHER AVE
Address2:  
City: TAMPA
State: FL
PostalCode: 336134613
CountryCode: US
TelephoneNumber: 8139716000
FaxNumber: 8139858006
Other Information
ProviderEnumerationDate: 02/06/2006
LastUpdateDate: 09/17/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XME82291FLY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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