MEDICARE: DR. RAFAEL JORGE MARRERO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	E-1292	AR
2	207Y00000X	Otolaryngology Physician	J2960	TX

General Provider Information

NPI Number	:	1437152329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFAEL JORGE MARRERO MD

Provider Business Mailing Address
First Line	:	2200 ADA AVE
Second Line	:	SUITE 202
City	:	CONWAY
State	:	AR
Zip	:	72034
Country	:	US
Telephone Number	:	501-327-3929
Fax Number	:	501-329-3816

Provider Business Practice Location Address
First Line	:	2200 ADA AVE
Second Line	:	SUITE 202
City	:	CONWAY
State	:	AR
Zip	:	72034
Country	:	US
Telephone Number	:	501-327-3929
Fax Number	:	501-329-3816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/21/2009

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