Healthcare Provider Details

I. General information

NPI: 1568426773
Provider Name (Legal Business Name): JOHN RAGHEB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

PO BOX 557367
MIAMI FL
33255-7367
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8386
  • Fax: 305-663-8490
Mailing address:
  • Phone: 786-624-5845
  • Fax: 786-624-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME71423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: