Provider Demographics
NPI:1811925548
Name:GOSALBEZ, RAFAEL (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:GOSALBEZ
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:PO BOX 277279
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7279
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:855-527-5510
Practice Address - Street 1:3200 SW 60TH CT STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4069
Practice Address - Country:US
Practice Address - Phone:305-669-6448
Practice Address - Fax:305-663-8485
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME634912088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370961200Medicaid
FL7911584OtherGHI
FL208048OtherAVMED
FL031838OtherNEIGHBORHOOD HEALTH PARTNERSHIP
FL148549OtherWELLCARE
FL17754OtherBLUE CROSS BLUE SHIELD
FL148549OtherSTAYWELL
FLF36985Medicare UPIN
FL17754XMedicare PIN