Provider Demographics
NPI:1497701718
Name:HATTAB, RAED ABDULA (MD)
Entity Type:Individual
Prefix:
First Name:RAED
Middle Name:ABDULA
Last Name:HATTAB
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 1:350 SE 2ND ST
Mailing Address - Street 2:STE 1640
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1919
Mailing Address - Country:US
Mailing Address - Phone:305-772-0347
Mailing Address - Fax:
Practice Address - Street 1:182 E REDSTONE AVE STE A
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5371
Practice Address - Country:US
Practice Address - Phone:855-527-7246
Practice Address - Fax:866-229-5063
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME915242081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI23705Medicare UPIN
FLU4062Medicare ID - Type Unspecified