Provider Demographics
NPI:1205938396
Name:RAFAEL L. NOGUES MD PA
Entity type:Organization
Organization Name:RAFAEL L. NOGUES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:NOGUES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-665-2812
Mailing Address - Street 1:5021 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-6730
Mailing Address - Country:US
Mailing Address - Phone:305-665-2812
Mailing Address - Fax:
Practice Address - Street 1:5021 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-6730
Practice Address - Country:US
Practice Address - Phone:305-665-2812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69090207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262311100Medicaid
FL262311100Medicaid
FL=========OtherEIN
FLF91797Medicare UPIN