Healthcare Provider Details

I. General information

NPI: 1699776443
Provider Name (Legal Business Name): DARAYES S. MOBED M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W. SAGAMORE AVENUE BUILDING D
CLEWISTON FL
33440-3514
US

IV. Provider business mailing address

540 W. SAGAMORE AVENUE BUILDING D
CLEWISTON FL
33440-3514
US

V. Phone/Fax

Practice location:
  • Phone: 863-983-5026
  • Fax: 863-983-2793
Mailing address:
  • Phone: 863-983-5026
  • Fax: 863-983-2793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number125186
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME20848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: