Healthcare Provider Details

I. General information

NPI: 1437788460
Provider Name (Legal Business Name): HAMID RAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 SOUTHERN BLVD
LOXAHATCHEE FL
33470-9203
US

IV. Provider business mailing address

4960 SW 72ND AVE STE 301
MIAMI FL
33155-5549
US

V. Phone/Fax

Practice location:
  • Phone: 877-832-2652
  • Fax: 877-454-6896
Mailing address:
  • Phone: 877-832-2652
  • Fax: 877-454-6896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number41387
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME168563
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: