Healthcare Provider Details

I. General information

NPI: 1760559827
Provider Name (Legal Business Name): RAFAEL MARIO SANCHEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 04/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 RB WILSON DR SUITE G
HUNTINGDON TN
38344
US

IV. Provider business mailing address

P.O. BOX 405827
ATLANTA GA
30384-5827
US

V. Phone/Fax

Practice location:
  • Phone: 731-986-7400
  • Fax: 731-986-7402
Mailing address:
  • Phone: 901-227-4068
  • Fax: 901-227-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number947
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD00000947
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0947
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number947
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS5820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: