Provider Demographics
NPI:1245599596
Name:RAZZOUK, ROZAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROZAN
Middle Name:
Last Name:RAZZOUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15230 SW 74TH CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2494
Mailing Address - Country:US
Mailing Address - Phone:305-998-8659
Mailing Address - Fax:
Practice Address - Street 1:6280 SW 72ND ST
Practice Address - Street 2:SUITE 410
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4827
Practice Address - Country:US
Practice Address - Phone:305-998-8659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL124551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine