Provider Demographics
NPI:1457553075
Name:RAZA, ALI (MD,)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:RAZA
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 1:20110 GULF BLVD APT 400
Mailing Address - Street 2:
Mailing Address - City:INDIAN SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33785-2452
Mailing Address - Country:US
Mailing Address - Phone:901-857-0370
Mailing Address - Fax:
Practice Address - Street 1:10500 ULMERTON RD STE 360
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3504
Practice Address - Country:US
Practice Address - Phone:901-857-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE51292085R0202X
FLME1031772085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology