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General NPI Number Information
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NPI Number | 1386610699
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Entity Type | Individual
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Provider Name | RAVI B MASIH M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | EMERGENCY DEPARTMENT, LAKE WALES MEDICAL CENTER 410 S 11TH STREET
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City | LAKE WALES
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State | FL
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Zip | 33853
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Country | US
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Telephone | 863-679-6811
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 780314
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City | SEBASTIAN
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State | FL
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Zip | 32978-0314
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Country | US
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Telephone | 722-087-6417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | ME75539
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036-111891
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License Number State | IL
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