1104898378 NPI number — RAFAEL A PAGAN M.D.

Table of content: RAFAEL A PAGAN M.D. (NPI 1104898378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104898378 NPI number — RAFAEL A PAGAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAGAN
Provider First Name:
RAFAEL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104898378
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RAF LAKENHEATH
Provider Second Line Business Mailing Address:
BOX 103
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
SUFFOLK
Provider Business Mailing Address Postal Code:
IP27 9PN
Provider Business Mailing Address Country Code:
GB
Provider Business Mailing Address Telephone Number:
00441638528407
Provider Business Mailing Address Fax Number:
00441638528407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RAF LAKENHEATH 48MDSS/SGSAR UNIT 5210
Provider Second Line Business Practice Location Address:
BOX 230
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
SUFFOLK
Provider Business Practice Location Address Postal Code:
IP27 9PN
Provider Business Practice Location Address Country Code:
GB
Provider Business Practice Location Address Telephone Number:
00441638528004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171000000X , with the licence number:  J2719 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)