Provider Demographics
NPI:1295998177
Name:SALAS, RAFAEL EMERICK (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:EMERICK
Last Name:SALAS
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 1:1402 NW 138TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-3030
Mailing Address - Country:US
Mailing Address - Phone:305-951-1545
Mailing Address - Fax:
Practice Address - Street 1:3050 BISCAYNE BLVD
Practice Address - Street 2:SUITE # 601
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4158
Practice Address - Country:US
Practice Address - Phone:786-505-8931
Practice Address - Fax:888-965-9608
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1082422086S0122X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery