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General NPI Number Information
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NPI Number | 1952688350
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Entity Type | Organization
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Legal Business Name | DAVID G. RAFFO MD PLLC
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 4452 BURTON FOREST CT SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8801
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Country | US
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Telephone | 616-635-6050
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Fax | 616-464-3223
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Provider Business Mailing Address
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Address Line | PO BOX 888842
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City | GRAND RAPIDS
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State | MI
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Zip | 49588-8842
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Country | US
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Telephone | 616-635-6050
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Fax | 616-464-3223
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Authorized Official
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Title or Position | OWNER
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Name | DAVID G RAFFO
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Credential | M.D,
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Telephone | 616-635-6050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301076928
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License Number State | MI
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