Provider Demographics
NPI:1093807075
Name:BELTRAN DURANGO, RAFAEL ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ALBERTO
Last Name:BELTRAN DURANGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4777 ROYAL PALM CIR NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3139
Mailing Address - Country:US
Mailing Address - Phone:727-894-2341
Mailing Address - Fax:727-894-2386
Practice Address - Street 1:3637 4TH ST N
Practice Address - Street 2:SUITE 480
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1355
Practice Address - Country:US
Practice Address - Phone:727-894-2341
Practice Address - Fax:727-894-2386
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME723102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G24421Medicare UPIN
FLE4642Medicare ID - Type Unspecified