Provider Demographics
NPI:1326069857
Name:BONES, RAPHAEL
Entity Type:Individual
Prefix:MR
First Name:RAPHAEL
Middle Name:
Last Name:BONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE E-214
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6741
Mailing Address - Country:US
Mailing Address - Phone:954-318-6590
Mailing Address - Fax:954-318-6604
Practice Address - Street 1:4151 HUNTERS PARK LN
Practice Address - Street 2:SUITE 132
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-3617
Practice Address - Country:US
Practice Address - Phone:407-251-4486
Practice Address - Fax:407-251-9386
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022251Medicare ID - Type UnspecifiedMEDICINA INTERNA