Basic Information
| Provider Information | |||||||||
| NPI: | 1194734954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALACIOS | ||||||||
| FirstName: | RAFAEL | ||||||||
| MiddleName: | ARMANDO | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHYSICIAN ASSISTANT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PALACIOS | ||||||||
| OtherFirstName: | RAFAEL | ||||||||
| OtherMiddleName: | ARMANDO | ||||||||
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| OtherCredential: | PAC | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2412 SE 27TH ST | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344710703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528677116 | ||||||||
| FaxNumber: | 3528677116 | ||||||||
| Practice Location | |||||||||
| Address1: | 1431 SW 1ST AVE | ||||||||
| Address2: | OCALA REGIONAL MEDICAL CENTER, DPMT OF EMERGENCY MED | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523517200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 12/17/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9103290 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 04573 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.