=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306007463
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAFAEL J ARCONE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2008
-----------------------------------------------------
Last Update Date | 03/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8200 SW 117TH AVE STE 304
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33183-4826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-226-5651
-----------------------------------------------------
Fax | 305-226-2424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 79 SW 12TH ST APT 1405
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33130-5203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-236-4992
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 148558
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------