Healthcare Provider Details

I. General information

NPI: 1043276488
Provider Name (Legal Business Name): RAUL VICENTE CHAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6285 SUNSET DR
SOUTH MIAMI FL
33143-4804
US

IV. Provider business mailing address

6285 SUNSET DR
SOUTH MIAMI FL
33143-4804
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-2925
  • Fax: 305-662-7840
Mailing address:
  • Phone: 305-662-2925
  • Fax: 305-662-7840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME76568
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME76568
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME76568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: