Provider Demographics
NPI:1437152329
Name:MARRERO, RAFAEL JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:JORGE
Last Name:MARRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RALPH
Other - Middle Name:J
Other - Last Name:MARRERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2200 ADA AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034
Mailing Address - Country:US
Mailing Address - Phone:501-327-3929
Mailing Address - Fax:501-329-3816
Practice Address - Street 1:2200 ADA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034
Practice Address - Country:US
Practice Address - Phone:501-327-3929
Practice Address - Fax:501-329-3816
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1292207Y00000X
TXJ2960207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG65941Medicare UPIN