Provider Demographics
NPI:1205954336
Name:BUSTO, RAFAEL PEDRO (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:PEDRO
Last Name:BUSTO
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 1:951 NW 13TH ST
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2359
Mailing Address - Country:US
Mailing Address - Phone:561-391-4200
Mailing Address - Fax:561-750-9474
Practice Address - Street 1:951 NW 13 STREET
Practice Address - Street 2:SUITE 5A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-391-4200
Practice Address - Fax:561-750-9474
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0023474207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71774OtherBCBS
FL71774OtherBCBS