Provider Demographics
NPI:1770640740
Name:NG, RAPHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:
Last Name:NG
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:PO BOX 3123
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:385 PALM COAST PKWY SW UNIT 5
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4784
Practice Address - Country:US
Practice Address - Phone:386-446-8333
Practice Address - Fax:386-446-3345
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057892208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7459511OtherAETNA
FL2699780OtherGHI
FL18488OtherBCBS
FL18488OtherBCBS