MEDICARE: DR. RAZA ALI M.D

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	2080A0000X	Pediatric Adolescent Medicine Physician	ME 0062109	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

General Provider Information

NPI Number	:	1770523482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAZA ALI M.D

Provider Business Mailing Address
First Line	:	5308 S JOHN YOUNG PKWY
Second Line	:	SUITE #200
City	:	ORLANDO
State	:	FL
Zip	:	32839-7362
Country	:	US
Telephone Number	:	407-240-9766
Fax Number	:	407-240-9508

Provider Business Practice Location Address
First Line	:	5308 S JOHN YOUNG PKWY
Second Line	:	SUITE #200
City	:	ORLANDO
State	:	FL
Zip	:	32839-7362
Country	:	US
Telephone Number	:	407-240-9766
Fax Number	:	407-240-9508

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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