Healthcare Provider Details

I. General information

NPI: 1497433932
Provider Name (Legal Business Name): RAFAEL CAVALCANTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

IV. Provider business mailing address

1600 HOSPITAL PKWY
BEDFORD TX
76022-6913
US

V. Phone/Fax

Practice location:
  • Phone: 601-288-4329
  • Fax: 601-288-3191
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number37642
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: