Provider Demographics
NPI:1346203742
Name:BURGOS, RAFAEL JR (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:BURGOS
Suffix:JR
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 1:7200 W COMMERCIAL BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2148
Mailing Address - Country:US
Mailing Address - Phone:502-489-2222
Mailing Address - Fax:305-256-6130
Practice Address - Street 1:7306 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3804
Practice Address - Country:US
Practice Address - Phone:305-220-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME055838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039780600Medicaid
09309BMedicare ID - Type Unspecified
FL039780600Medicaid