MEDICARE: RAFAEL LEONARDO PRIETO M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	40917	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699710426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL LEONARDO PRIETO M.D.

Provider Business Mailing Address
First Line	:	353 NEW SHACKLE ISLAND RD STE 148C
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-2366
Country	:	US
Telephone Number	:	615-972-1100
Fax Number	:	615-537-4950

Provider Business Practice Location Address
First Line	:	3443 DICKERSON PIKE STE 730
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37207-2527
Country	:	US
Telephone Number	:	615-972-1100
Fax Number	:	615-537-4950

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	07/21/2021

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