Provider Demographics
NPI:1952372609
Name:AFLAK, RAFAH (MD)
Entity Type:Individual
Prefix:
First Name:RAFAH
Middle Name:
Last Name:AFLAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CROSSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-6586
Mailing Address - Country:US
Mailing Address - Phone:850-478-5440
Mailing Address - Fax:850-478-5447
Practice Address - Street 1:185 CROSSVILLE ST
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-6586
Practice Address - Country:US
Practice Address - Phone:850-478-5440
Practice Address - Fax:850-478-5447
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME768262080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258104300Medicaid
FL44946OtherBLUE CROSS BLUE SHIELD
AL59147365OtherBLUE CROSS BLUE SHIELD
FLA853OtherHEALTH FIRST NETWORK
FLME76826OtherMEDICAL LICENSE
FL44946Medicare ID - Type UnspecifiedMEDICARE
FLA853OtherHEALTH FIRST NETWORK