=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437788460
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAMID RAZA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2020
-----------------------------------------------------
Last Update Date | 10/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13001 SOUTHERN BLVD
-----------------------------------------------------
City | LOXAHATCHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33470-9203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-832-2652
-----------------------------------------------------
Fax | 877-454-6896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4960 SW 72ND AVE STE 301
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-5549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-832-2652
-----------------------------------------------------
Fax | 877-454-6896
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 41387
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME168563
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------