Provider Demographics
NPI:1386754562
Name:RADEN, ROBERT W (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:RADEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
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:
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME93297207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277250700Medicaid
FL03101OtherBCBS
FLAD076XMedicare PIN
FL277250700Medicaid
FLAD076YMedicare PIN
FLAD076ZMedicare PIN
FLAD076VMedicare PIN