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General NPI Number Information
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NPI Number | 1659477305
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Entity Type | Individual
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Provider Name | RAFAEL M BONILLA-MARQUEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 2605 W SWANN AVE STE 100
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City | TAMPA
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State | FL
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Zip | 33609-4039
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Country | US
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Telephone | 813-874-5500
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Fax | 813-874-5505
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Provider Business Mailing Address
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Address Line | PO BOX 22205
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City | BELFAST
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State | ME
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Zip | 04915-4473
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Country | US
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Telephone | 813-874-5500
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Fax | 813-874-5505
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME0046378
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License Number State | FL
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