Healthcare Provider Details

I. General information

NPI: 1104880533
Provider Name (Legal Business Name): RAYMOND B SANDLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 170TH ST SUITE 410
NORTH MIAMI BEACH FL
33169-5513
US

IV. Provider business mailing address

100 NW 170TH ST SUITE # 410
NORTH MIAMI BEACH FL
33169-5513
US

V. Phone/Fax

Practice location:
  • Phone: 305-654-6850
  • Fax: 305-654-6858
Mailing address:
  • Phone: 305-654-6850
  • Fax: 305-654-6858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME0075598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: