Provider Demographics
NPI:1811002330
Name:TAPIA, RAUL H
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:H
Last Name:TAPIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 N FEDERAL HWY
Mailing Address - Street 2:PATHOLOGY DEPT
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4603
Mailing Address - Country:US
Mailing Address - Phone:954-492-5728
Mailing Address - Fax:954-776-3258
Practice Address - Street 1:4725 N FEDERAL HWY
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-492-5728
Practice Address - Fax:954-776-3258
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40235207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035566600Medicaid
FLO63921Medicare UPIN
FL035566600Medicaid