Provider Demographics
NPI:1922168145
Name:ROBERT RADEN MD LLC
Entity Type:Organization
Organization Name:ROBERT RADEN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RADEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-499-8830
Mailing Address - Street 1:5130 LINTON BLVD
Mailing Address - Street 2:F7
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6596
Mailing Address - Country:US
Mailing Address - Phone:561-499-8830
Mailing Address - Fax:561-637-8077
Practice Address - Street 1:5130 LINTON BLVD
Practice Address - Street 2:F7
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-499-8830
Practice Address - Fax:561-637-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 93297207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF304Medicare PIN