Healthcare Provider Details

I. General information

NPI: 1104898378
Provider Name (Legal Business Name): RAFAEL A PAGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RAF LAKENHEATH 48MDSS/SGSAR UNIT 5210 BOX 230
BRANDON SUFFOLK
IP27 9PN
GB

IV. Provider business mailing address

RAF LAKENHEATH BOX 103
BRANDON SUFFOLK
IP27 9PN
GB

V. Phone/Fax

Practice location:
  • Phone: 00441638528004
  • Fax:
Mailing address:
  • Phone: 00441638528407
  • Fax: 00441638528407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberJ2719
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: