Provider Demographics
NPI:1144215617
Name:GOTTENGER, RAFAEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:DAVID
Last Name:GOTTENGER
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:PO BOX 431900
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-1900
Mailing Address - Country:US
Mailing Address - Phone:305-669-0900
Mailing Address - Fax:305-669-0100
Practice Address - Street 1:7330 SW 62ND PL
Practice Address - Street 2:SUITE #205
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4825
Practice Address - Country:US
Practice Address - Phone:305-669-0900
Practice Address - Fax:305-669-0100
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91263208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272290900Medicaid
FLK7623Medicare ID - Type Unspecified
FL272290900Medicaid