Provider Demographics
NPI:1851483838
Name:RAFAEL BELTRAN MD PA
Entity Type:Organization
Organization Name:RAFAEL BELTRAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:BELTRAN DURANGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-894-2341
Mailing Address - Street 1:4777 ROYAL PALM CIR NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3139
Mailing Address - Country:US
Mailing Address - Phone:727-894-2341
Mailing Address - Fax:727-894-2386
Practice Address - Street 1:3637 4TH ST N
Practice Address - Street 2:SUITE 480
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1355
Practice Address - Country:US
Practice Address - Phone:727-894-2341
Practice Address - Fax:727-894-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME723102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDS759AMedicare PIN