Provider Demographics
NPI:1518909712
Name:ROYBAL, RAPHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:R
Last Name:ROYBAL
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 1:4425 PAULSEN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3637
Mailing Address - Country:US
Mailing Address - Phone:912-355-6615
Mailing Address - Fax:912-354-5970
Practice Address - Street 1:4425 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3637
Practice Address - Country:US
Practice Address - Phone:912-355-6615
Practice Address - Fax:912-354-5970
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAG58216207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA380889540AMedicaid
P00336983OtherRAILROAD MEDICARE
GABR9259397OtherDEA
GA20NCCPZMedicare PIN
GABR9259397OtherDEA
GA4954440002Medicare NSC