Provider Demographics
NPI:1821075532
Name:CHUA, RAYMUND (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMUND
Middle Name:
Last Name:CHUA
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 1:906 MOONLUSTER DR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3437
Mailing Address - Country:US
Mailing Address - Phone:407-637-5247
Mailing Address - Fax:
Practice Address - Street 1:5355 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4909
Practice Address - Country:US
Practice Address - Phone:321-304-3300
Practice Address - Fax:321-304-3287
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 95592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB516ZMedicare PIN
G48079Medicare UPIN