Provider Demographics
NPI:1902860869
Name:CAMPO, RAFAEL E (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:E
Last Name:CAMPO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1500 NW 12TH AVE
Mailing Address - Street 2:JMT-EAST 1007
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1028
Mailing Address - Country:US
Mailing Address - Phone:305-243-4664
Mailing Address - Fax:305-243-4037
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:BOX 016960 M851
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-243-6484
Practice Address - Fax:305-243-4037
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2012-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME57111207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3752674-00Medicaid
FLF78264Medicare UPIN
FL3752674-00Medicaid