Healthcare Provider Details

I. General information

NPI: 1609114867
Provider Name (Legal Business Name): LANCE P. RAIFFE, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD SUITE 620
MIAMI BEACH FL
33140-2891
US

IV. Provider business mailing address

4302 ALTON RD SUITE 620
MIAMI BEACH FL
33140-2891
US

V. Phone/Fax

Practice location:
  • Phone: 305-538-8658
  • Fax: 305-531-5827
Mailing address:
  • Phone: 305-538-8658
  • Fax: 305-531-5827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number47810
License Number StateFL

VIII. Authorized Official

Name: DR. LANCE P RAIFFE
Title or Position: PD
Credential: M.D.
Phone: 305-538-8658