Provider Demographics
NPI:1659471639
Name:MAYOR, RAFAEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:DAVID
Last Name:MAYOR
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 1:287 HEALTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-2031
Mailing Address - Country:US
Mailing Address - Phone:334-792-9500
Mailing Address - Fax:334-793-1815
Practice Address - Street 1:287 HEALTHWEST DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2031
Practice Address - Country:US
Practice Address - Phone:334-792-9500
Practice Address - Fax:334-793-1815
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9173207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51081377OtherBLUE CROSS & BLUE SHIELD
AL000087123Medicaid
GA00438787AMedicaid
AL000081377Medicaid
AL110052488OtherPALMETTO GBA RR MEDICARE
AL51087123OtherBLUE CROSS & BLUE SHIELD
AL51081377OtherBLUE CROSS & BLUE SHIELD
AL000081377Medicare ID - Type Unspecified
AL000087123Medicare ID - Type Unspecified
AL0342610004Medicare NSC
AL0342610001Medicare NSC