Provider Demographics
NPI:1144387408
Name:RAPHAEL, ROBERT IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:IAN
Last Name:RAPHAEL
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 1:1384 10TH AVE
Mailing Address - Street 2:SAN FRANCISCO
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2304
Mailing Address - Country:US
Mailing Address - Phone:415-566-8102
Mailing Address - Fax:
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:DEPARTMENT OF HEMATOLOGY-ONCOLOGY
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA813182080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A813180Medicaid
CA00A813180Medicare ID - Type Unspecified
CAI22076Medicare UPIN