Provider Demographics
NPI:1255306213
Name:RAPHAEL, BERND (MD)
Entity Type:Individual
Prefix:DR
First Name:BERND
Middle Name:
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 1:470 LEE BLVD
Mailing Address - Street 2:470 LEE BLVD
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-4923
Mailing Address - Country:US
Mailing Address - Phone:239-368-7270
Mailing Address - Fax:239-368-2741
Practice Address - Street 1:470 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4923
Practice Address - Country:US
Practice Address - Phone:239-368-7270
Practice Address - Fax:239-368-2741
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D1010127OtherCLIA
FL200632493OtherCOMMERICAL AND TAX ID
FL51345OtherBCBS
FL10D1010127OtherCLIA
FL51345OtherBCBS
FL51345ZMedicare PIN