MEDICARE: DR. RAUL E DAZA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME96199	FL
2	208M00000X	Hospitalist Physician	ME96199	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ME96199	OTHER	FL	MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164432050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAUL E DAZA MD

Provider Business Mailing Address
First Line	:	8400 NW 33RD ST
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33122-1937
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18610 NW 87TH AVE
Second Line	:	SUITE 101 AND 201
City	:	HIALEAH
State	:	FL
Zip	:	33015-3518
Country	:	US
Telephone Number	:	844-665-4827
Fax Number	:	305-829-5033

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	02/22/2017

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Directions to “ DR. RAUL E DAZA MD” Practice Location

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