Organization
TABRAUE ORTHOPEDIC MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAUL TABRAUE (PRESIDENT)
(305) 649-4460
Entity
Organization
Contact information
Practice address
106 SW 16TH AVE, MIAMI, FL 33135-2116
(305) 649-4460
(305) 649-9249
Mailing address
106 SW 16TH AVE, MIAMI, FL 33135-2116
(305) 649-4460
(305) 649-9249
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
ORF189
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01995024
AMERIGROUP FLORIDA
FL
05
—
028394100
—
FL
01
—
2025
AHCA
FL
01
—
323217
MEDICAL OXYGEN RETAILER
FL
01
—
693458796
MEDICAID WAIVER
FL
01
—
M2813
BLUECROSS BLUESHIELD OF FLORIDA
FL
01
—
MCC600932603
MAGELLAN COMPLETE CARE
FL
01
—
QMP000004742490
MOLINA
FL
01
—
S10585
BOARD FRO ORTHOTIST/PROSTHETIST CERTIFICATION
FL
Enumeration date
05/08/2006
Last updated
04/12/2016
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