Provider Demographics
NPI:1851741813
Name:BENEZRA ROMAN, RAFAEL RICARDO
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:RICARDO
Last Name:BENEZRA ROMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10280 PINES BLVD STE P701
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-6057
Mailing Address - Country:US
Mailing Address - Phone:954-323-8446
Mailing Address - Fax:954-323-8207
Practice Address - Street 1:10280 PINES BLVD STE P701
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-6057
Practice Address - Country:US
Practice Address - Phone:954-323-8446
Practice Address - Fax:954-323-8207
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137192207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine