Provider Demographics
NPI:1922030071
Name:RAEZ, LUIS E (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:RAEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:801 N FLAMINGO RD
Practice Address - Street 2:SUITE 11
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1046
Practice Address - Country:US
Practice Address - Phone:954-844-6868
Practice Address - Fax:954-443-4747
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-03-18
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Provider Licenses
StateLicense IDTaxonomies
FLME71292207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2540321-00Medicaid
G43389Medicare UPIN
FL2540321-00Medicaid