Provider Demographics
NPI:1437313491
Name:NARAEV, BORIS GENRIKHOVICH (MD, PHD, FACP)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:GENRIKHOVICH
Last Name:NARAEV
Suffix:
Gender:M
Credentials:MD, PHD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-7585
Mailing Address - Fax:813-844-5877
Practice Address - Street 1:10740 PALM RIVER RD STE 360
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4578
Practice Address - Country:US
Practice Address - Phone:813-844-7585
Practice Address - Fax:813-844-5877
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME145544207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA719260094Medicare PIN