Provider Demographics
NPI:1598758492
Name:RAFLO, GARY T (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:T
Last Name:RAFLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:201 LE PHILLIP CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2900
Mailing Address - Country:US
Mailing Address - Phone:704-782-1127
Mailing Address - Fax:704-782-1207
Practice Address - Street 1:201 LE PHILLIP CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2900
Practice Address - Country:US
Practice Address - Phone:704-782-1127
Practice Address - Fax:704-782-1207
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC35473207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10396OtherBLUE CROSS
NC8910396Medicaid
NC8910396Medicaid
NC10396OtherBLUE CROSS