Healthcare Provider Details

I. General information

NPI: 1700414067
Provider Name (Legal Business Name): HUNTER RAFOTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 N WICKHAM RD
MELBOURNE FL
32940-7304
US

IV. Provider business mailing address

60 COLUMBIA ST STE 400
ORLANDO FL
32806-1115
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-5851
  • Fax: 407-573-3355
Mailing address:
  • Phone: 321-843-5851
  • Fax: 321-843-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023-00836
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2023-00836
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME152929
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: