Provider Demographics
NPI:1326316183
Name:RAFAEL J NOBO JR M.D., P.A.
Entity Type:Organization
Organization Name:RAFAEL J NOBO JR M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOBO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:863-533-8944
Mailing Address - Street 1:222 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-4531
Mailing Address - Country:US
Mailing Address - Phone:863-533-8944
Mailing Address - Fax:863-533-1577
Practice Address - Street 1:222 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4531
Practice Address - Country:US
Practice Address - Phone:863-533-8944
Practice Address - Fax:863-533-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41315207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53722OtherMEDICARE
FLD86026Medicare UPIN