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General NPI Number Information
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NPI Number | 1568968360
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Entity Type | Individual
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Provider Name | BRIAN SCOTT RAITZIN MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 3341 JOHNSON ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5419
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Country | US
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Telephone | 954-265-3982
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Fax | 954-893-6518
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Provider Business Mailing Address
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Address Line | 2900 CORPORATE WAY DOOR D
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City | MIRAMAR
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State | FL
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Zip | 33025-3925
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Country | US
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Telephone | 954-276-5603
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Fax | 954-985-7074
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME168294
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License Number State | FL
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