MEDICARE: DR. ENRIQUE DAZA RACINES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	19033	DC
2	2086S0127X	Trauma Surgery Physician	BD42181	MD
3	208600000X	Surgery Physician	D42181	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649229634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENRIQUE DAZA RACINES M.D.

Provider Business Mailing Address
First Line	:	5602B SHIELDS DR
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-3571
Country	:	US
Telephone Number	:	301-897-0044
Fax Number	:	301-897-0046

Provider Business Practice Location Address
First Line	:	5602B SHIELDS DR
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-3571
Country	:	US
Telephone Number	:	301-897-0044
Fax Number	:	301-897-0046

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	11/10/2014

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