Provider Demographics
NPI:1619081924
Name:RAFAEL, RICHARD W (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:RAFAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICAHRD
Other - Middle Name:W
Other - Last Name:RAFAEL, CHARTERED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:770 MILL ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1321
Mailing Address - Country:US
Mailing Address - Phone:775-323-4545
Mailing Address - Fax:775-323-4869
Practice Address - Street 1:770 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1321
Practice Address - Country:US
Practice Address - Phone:775-323-4545
Practice Address - Fax:775-323-4869
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5289207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016832Medicaid
NV002016832Medicaid