MEDICARE: RAYMOND HOA BINH LY MD

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	208D00000X	General Practice Physician	ME45840	FL

General Provider Information

NPI Number	:	1689641854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND HOA BINH LY MD

Provider Business Mailing Address
First Line	:	8990 ELIZABETH FALLS DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5398
Country	:	US
Telephone Number	:	407-943-7010
Fax Number	:	407-343-2002

Provider Business Practice Location Address
First Line	:	1875 BOGGY CREEK RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-4428
Country	:	US
Telephone Number	:	407-943-7010
Fax Number	:	407-343-2002

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	07/08/2007

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