Provider Demographics
NPI:1568667715
Name:RONDON, RAFAEL AUGUSTO (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:AUGUSTO
Last Name:RONDON
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 1:5331 PRIMROSE LAKE CIR STE 112
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3764
Mailing Address - Country:US
Mailing Address - Phone:813-517-4629
Mailing Address - Fax:813-200-1036
Practice Address - Street 1:5331 PRIMROSE LAKE CIR STE 112
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3764
Practice Address - Country:US
Practice Address - Phone:813-517-4629
Practice Address - Fax:813-200-1036
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100751207R00000X, 207RG0300X
VA0101242340207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK669ZOtherMEDICARE
FLAK669ZOtherMEDICARE