Provider Demographics
NPI:1144210238
Name:ELIAZER, RAJ M (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJ
Middle Name:M
Last Name:ELIAZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W DR MLK BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6378
Mailing Address - Country:US
Mailing Address - Phone:813-321-1429
Mailing Address - Fax:813-443-8117
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6378
Practice Address - Country:US
Practice Address - Phone:813-321-1429
Practice Address - Fax:813-321-1431
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME943012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274031100Medicaid
PA1852471Medicaid
0A8275Medicare ID - Type Unspecified
FL29599YMedicare PIN
FL29599ZMedicare PIN
FL274031100Medicaid