MEDICARE: RAFAEL J DELIZ MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	N2057	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11136884	OTHER	TX	CAQH

General Provider Information

NPI Number	:	1952533770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAFAEL J DELIZ MD PA

Provider Business Mailing Address
First Line	:	9114 MCPHERSON RD
Second Line	:	STE 2509
City	:	LAREDO
State	:	TX
Zip	:	78045-6511
Country	:	US
Telephone Number	:	956-795-1887
Fax Number	:	956-795-1476

Provider Business Practice Location Address
First Line	:	9114 MC PHERSON RD
Second Line	:	STE 2509
City	:	LAREDO
State	:	TX
Zip	:	78045-6511
Country	:	US
Telephone Number	:	956-795-1887
Fax Number	:	956-795-1476

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RAFAEL J DELIZ
Credential	:	M.D.
Telephone Number	:	956-220-4597

Provider Enumeration Date	:	08/12/2009
Last Update Date	:	01/18/2017

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