Provider Demographics
NPI:1528006806
Name:RAKOV, NEAL E (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:E
Last Name:RAKOV
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 1:91550 OVERSEAS HIGHWAY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2141
Mailing Address - Country:US
Mailing Address - Phone:305-852-9400
Mailing Address - Fax:305-852-6457
Practice Address - Street 1:933 BRADBURY DR SE STE 2222
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4375
Practice Address - Country:US
Practice Address - Phone:505-272-3120
Practice Address - Fax:505-272-8060
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73295207RG0100X
NM89-90207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41544OtherBLUE CROSS BLUE SHIELD
FL252372800Medicaid
FL850372521OtherCHAMPUS
FL252372800Medicaid