Provider Demographics
NPI:1851648984
Name:GROZMAN, RAFAEL JOSE MUNOZ (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL JOSE
Middle Name:MUNOZ
Last Name:GROZMAN
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 1:417 STATE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6690
Mailing Address - Country:US
Mailing Address - Phone:207-942-6096
Mailing Address - Fax:207-973-8857
Practice Address - Street 1:417 STATE ST STE 400
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-942-6096
Practice Address - Fax:207-973-8857
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21937207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty