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General NPI Number Information
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NPI Number | 1437152329
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Entity Type | Individual
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Provider Name | RAFAEL JORGE MARRERO MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 2200 ADA AVE SUITE 202
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City | CONWAY
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State | AR
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Zip | 72034
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Country | US
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Telephone | 501-327-3929
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Fax | 501-329-3816
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Provider Business Mailing Address
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Address Line | 2200 ADA AVE SUITE 202
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City | CONWAY
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State | AR
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Zip | 72034
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Country | US
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Telephone | 501-327-3929
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Fax | 501-329-3816
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | E-1292
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | J2960
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License Number State | TX
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