Healthcare Provider Details

I. General information

NPI: 1619081924
Provider Name (Legal Business Name): RICHARD W RAFAEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICAHRD W RAFAEL, CHARTERED M.D.

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 MILL ST
RENO NV
89502-1321
US

IV. Provider business mailing address

770 MILL ST
RENO NV
89502-1321
US

V. Phone/Fax

Practice location:
  • Phone: 775-323-4545
  • Fax: 775-323-4869
Mailing address:
  • Phone: 775-323-4545
  • Fax: 775-323-4869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number5289
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: