Provider Demographics
NPI:1518142413
Name:SIERRA, RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:SIERRA
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 1:2825 N STATE ROAD 7 STE 300
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5737
Mailing Address - Country:US
Mailing Address - Phone:954-975-0350
Mailing Address - Fax:954-975-3465
Practice Address - Street 1:2825 N STATE ROAD 7 STE 300
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5737
Practice Address - Country:US
Practice Address - Phone:954-975-0350
Practice Address - Fax:954-975-3465
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.30498208600000X
FLME119813208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHY1012OtherMEDICARE
FL012390200Medicaid
ALD570OtherMEDICARE
AL529203130OtherMEDICAID
AL124739Medicaid
ALD570OtherMEDICARE