Provider Demographics
NPI:1588670061
Name:NOBO, RAFAEL JACINTO JR (MD,PA)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:JACINTO
Last Name:NOBO
Suffix:JR
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:RALPH
Other - Middle Name:J
Other - Last Name:NOBO
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD,PA
Mailing Address - Street 1:222 WEST MAIN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-4531
Mailing Address - Country:US
Mailing Address - Phone:863-533-8944
Mailing Address - Fax:863-533-1577
Practice Address - Street 1:222 WEST MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4531
Practice Address - Country:US
Practice Address - Phone:863-533-8944
Practice Address - Fax:863-533-1577
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041315207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D86026Medicare UPIN
53722Medicare ID - Type Unspecified