Provider Demographics
NPI: | 1477806438 |
---|---|
Name: | RAFALKO, JOHN W (EDD, PA-C) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JOHN |
Middle Name: | W |
Last Name: | RAFALKO |
Suffix: | |
Gender: | M |
Credentials: | EDD, PA-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | DR. JOHN W. RAFALKO, 3200 SOUTH UNIVERSITY DR. |
Mailing Address - Street 2: | NSU, HPD, CHCS, PA DEPARTMENT, ROOM 1287 |
Mailing Address - City: | FORT LAUDERDALE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33328-2018 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-262-1287 |
Mailing Address - Fax: | 954-262-2285 |
Practice Address - Street 1: | DR. JOHN W. RAFALKO, 3200 SOUTH UNIVERSITY DR. |
Practice Address - Street 2: | NSU, HPD, CHCS, PA DEPARTMENT, ROOM 1287 |
Practice Address - City: | FORT LAUDERDALE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33328-2018 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-262-1287 |
Practice Address - Fax: | 954-262-2285 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2012-10-16 |
Last Update Date: | 2012-10-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 7937253 | 363A00000X |
MD | C0001101 | 363A00000X |
GA | 1016380 PA-C NCCPA# | 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |