Provider Demographics
NPI:1932201373
Name:SANTIAGO APONTE, RAFAEL ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ALBERTO
Last Name:SANTIAGO APONTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:ALBERTO
Other - Last Name:SANTIAGO APONTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:239 LAKE LINK RD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-1006
Mailing Address - Country:US
Mailing Address - Phone:863-399-8828
Mailing Address - Fax:
Practice Address - Street 1:40100 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-5906
Practice Address - Country:US
Practice Address - Phone:863-422-4971
Practice Address - Fax:863-419-2264
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114771207P00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0090040Medicare ID - Type Unspecified
H04012Medicare UPIN