Provider Demographics
NPI:1912213786
Name:PEDRO MUSA RIS, M.D. P.A.
Entity Type:Organization
Organization Name:PEDRO MUSA RIS, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSA RIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-649-6199
Mailing Address - Street 1:510 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2971
Mailing Address - Country:US
Mailing Address - Phone:305-649-6199
Mailing Address - Fax:305-649-6566
Practice Address - Street 1:510 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2971
Practice Address - Country:US
Practice Address - Phone:305-649-6199
Practice Address - Fax:305-649-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME14082207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91605EMedicare PIN