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General NPI Number Information
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NPI Number | 1477806438
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Entity Type | Individual
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Provider Name | JOHN W. RAFALKO ED.D., PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | DR. JOHN W. RAFALKO, 3200 SOUTH UNIVERSITY DR. NSU, HPD, CHCS, PA DEPARTMENT, ROOM 1287
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City | FORT LAUDERDALE
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State | FL
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Zip | 33328-2018
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Country | US
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Telephone | 954-262-1287
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Fax | 954-262-2285
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Provider Business Mailing Address
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Address Line | DR. JOHN W. RAFALKO, 3200 SOUTH UNIVERSITY DR. NSU, HPD, CHCS, PA DEPARTMENT, ROOM 1287
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City | FORT LAUDERDALE
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State | FL
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Zip | 33328-2018
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Country | US
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Telephone | 954-262-1287
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Fax | 954-262-2285
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7937253
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0001101
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1016380 PA-C NCCPA#
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License Number State | GA
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