Provider Demographics
NPI:1629144795
Name:MARTINEZ, RAFAEL A (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:MARTINEZ
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 1:4308 N HABANA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6316
Mailing Address - Country:US
Mailing Address - Phone:813-490-9495
Mailing Address - Fax:813-874-0099
Practice Address - Street 1:4308 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6316
Practice Address - Country:US
Practice Address - Phone:813-490-9495
Practice Address - Fax:813-874-0099
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FLME79829207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264303100Medicaid
FL264303100Medicaid
FLH63655Medicare UPIN