Provider Demographics
NPI:1063471829
Name:GONZALEZ CASTRO, RAFAEL ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ANGEL
Last Name:GONZALEZ CASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S MARION AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-5808
Mailing Address - Country:US
Mailing Address - Phone:386-755-3016
Mailing Address - Fax:386-754-6352
Practice Address - Street 1:619 S MARION AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:386-754-6352
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20469OtherTRIPLE SSS
PR300115OtherMMM
PRA-040OtherFIRST MEDICAL/ IMC
PR03827OtherAMERICAN HEALTH
PR100649OtherCRUZ AZUL
PR200-365OtherPREFERRED HEALTH
PR36-0306-7OtherACAA
PRPE-4847OtherPALIC
PR716-0040OtherHUMANA HEALTH PLAN
PR115-12332OtherGLOBAL HEALTH PLAN
PR20469OtherAUXILIO PLATINO
PR3612332OtherUIA
PR3883OtherPREFERRED MEDICARE CHOICE
PR36-0306-7OtherACAA
PRA-040OtherFIRST MEDICAL/ IMC