Provider Demographics
NPI:1467495671
Name:RAFFEL, ROBERT EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWIN
Last Name:RAFFEL
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:PO BOX 39179
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-9179
Mailing Address - Country:US
Mailing Address - Phone:602-395-0718
Mailing Address - Fax:602-277-8146
Practice Address - Street 1:7600 N 16TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4431
Practice Address - Country:US
Practice Address - Phone:602-395-0718
Practice Address - Fax:602-277-8146
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23197207L00000X
FLME0018394207L00000X
FLME 89063207L00000X
IL36043325207L00000X
AZ30041207L00000X
CO40703207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G231970Medicaid
CA00G231970Medicaid
CA00G231972Medicare PIN
CAAR355XMedicare PIN
CAWG23197CMedicare ID - Type Unspecified