Healthcare Provider Details

I. General information

NPI: 1780614578
Provider Name (Legal Business Name): A RAFAEL ROURE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DWIGHT D EISENHOWER ARMY MEDICAL CENTER
FT GORDON GA
30905
US

IV. Provider business mailing address

35202 3RD AVE #370
FT GORDON GA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-6158
  • Fax:
Mailing address:
  • Phone: 904-651-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME72475
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME 72475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: