Provider Demographics
NPI:1497853741
Name:ALFONZO, RAFAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:E
Last Name:ALFONZO
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 1:2010 S MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1517
Mailing Address - Country:US
Mailing Address - Phone:305-458-1983
Mailing Address - Fax:305-858-4262
Practice Address - Street 1:2010 S MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-1517
Practice Address - Country:US
Practice Address - Phone:305-458-1983
Practice Address - Fax:305-858-4262
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27650207Y00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0657696400Medicaid
FL78497Medicare ID - Type UnspecifiedDOCTOR MEDICARE PROVIDER