Provider Demographics
NPI:1699776443
Name:MOBED, DARAYES S (MD)
Entity type:Individual
Prefix:MR
First Name:DARAYES
Middle Name:S
Last Name:MOBED
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 1:540 W. SAGAMORE AVENUE
Mailing Address - Street 2:BUILDING D
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3514
Mailing Address - Country:US
Mailing Address - Phone:863-983-5026
Mailing Address - Fax:863-983-2793
Practice Address - Street 1:540 W. SAGAMORE AVENUE
Practice Address - Street 2:BUILDING D
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3514
Practice Address - Country:US
Practice Address - Phone:863-983-5026
Practice Address - Fax:863-983-2793
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125186207X00000X
FLME20848174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280857900Medicaid
NYB13191Medicare UPIN
FLA17742Medicare PIN