Provider Demographics
NPI:1700055878
Name:ROSARIO, RAFAEL RADHAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:RADHAMES
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAFAEL
Other - Middle Name:R
Other - Last Name:ROSARIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7625 SW 62ND CT STE 100
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-8322
Mailing Address - Country:US
Mailing Address - Phone:352-237-8903
Mailing Address - Fax:352-237-8962
Practice Address - Street 1:7625 SW 62ND CT STE 100
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476
Practice Address - Country:US
Practice Address - Phone:352-237-8903
Practice Address - Fax:352-237-8962
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN560208D00000X
PR16981208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN560OtherMEDICAL LICENSE
FL715106Medicaid