Provider Demographics
NPI:1790998714
Name:DALVI, RAHUL PRAKASH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:PRAKASH
Last Name:DALVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44004
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4004
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:820 PRUDENTIAL DR
Practice Address - Street 2:SUITE 304
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8210
Practice Address - Country:US
Practice Address - Phone:904-348-0974
Practice Address - Fax:904-348-5627
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019010200Medicaid
FLP01745293OtherRR MEDICARE
FLIS625ZMedicare PIN