Provider Demographics
NPI:1760559827
Name:SANCHEZ, RAFAEL MARIO (DO)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:MARIO
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:901-227-4068
Mailing Address - Fax:901-227-4001
Practice Address - Street 1:641 RB WILSON DR
Practice Address - Street 2:SUITE G
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344
Practice Address - Country:US
Practice Address - Phone:731-986-7400
Practice Address - Fax:731-986-7402
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND00000947207Q00000X
TN947207P00000X, 207Q00000X
TN0947207Q00000X
FLOS5820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3733244Medicaid
TNP00694510OtherRR MEDICARE
TN3733244Medicaid
TNP00694510OtherRR MEDICARE
F40238Medicare UPIN
TN33031102Medicare PIN
TN33031103Medicare PIN
103I935151Medicare PIN