Healthcare Provider Details

I. General information

NPI: 1104812916
Provider Name (Legal Business Name): RAUL MOAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 01/28/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 S MIAMI AVE SUITE 5004
MIAMI FL
33133-4227
US

IV. Provider business mailing address

15680 N KENDALL DR SUITE 201
MIAMI FL
33196-1159
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-0616
  • Fax: 305-854-4384
Mailing address:
  • Phone: 305-436-9933
  • Fax: 305-436-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME42676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: