1194734954 NPI number — MR. RAFAEL ARMANDO PALACIOS PHYSICIAN ASSISTANT

Table of content: (NPI 1568481265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194734954 NPI number — MR. RAFAEL ARMANDO PALACIOS PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALACIOS
Provider First Name:
RAFAEL
Provider Middle Name:
ARMANDO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PALACIOS
Provider Other First Name:
RAFAEL
Provider Other Middle Name:
ARMANDO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PAC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1194734954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2412 SE 27TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-0703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-867-7116
Provider Business Mailing Address Fax Number:
352-867-7116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1431 SW 1ST AVE
Provider Second Line Business Practice Location Address:
OCALA REGIONAL MEDICAL CENTER, DPMT OF EMERGENCY MED
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-351-7200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2006

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: 363AM0700X , with the licence number:  PA9103290 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: 04573 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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