Healthcare Provider Details

I. General information

NPI: 1154598258
Provider Name (Legal Business Name): RAED HATTAB PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SE 2ND ST STE 1640
FORT LAUDERDALE FL
33301-1919
US

IV. Provider business mailing address

350 SE 2ND ST STE 1640
FORT LAUDERDALE FL
33301-1919
US

V. Phone/Fax

Practice location:
  • Phone: 305-772-0347
  • Fax: 954-473-0211
Mailing address:
  • Phone: 305-772-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAED HATTAB
Title or Position: PRESIDENT
Credential: MD
Phone: 305-772-0347