Healthcare Provider Details

I. General information

NPI: 1821075532
Provider Name (Legal Business Name): RAYMUND CHUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5355 RED BUG LAKE RD
WINTER SPRINGS FL
32708-4909
US

IV. Provider business mailing address

906 MOONLUSTER DR
CASSELBERRY FL
32707-3437
US

V. Phone/Fax

Practice location:
  • Phone: 321-304-3300
  • Fax: 321-304-3287
Mailing address:
  • Phone: 407-637-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 95592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: