Provider Demographics
NPI:1104898378
Name:PAGAN, RAFAEL A (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:PAGAN
Suffix:
Gender:M
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:RAF LAKENHEATH
Mailing Address - Street 2:BOX 103
Mailing Address - City:BRANDON
Mailing Address - State:SUFFOLK
Mailing Address - Zip Code:IP27 9PN
Mailing Address - Country:GB
Mailing Address - Phone:0044163-852-8407
Mailing Address - Fax:0044163-852-8407
Practice Address - Street 1:RAF LAKENHEATH 48MDSS/SGSAR UNIT 5210
Practice Address - Street 2:BOX 230
Practice Address - City:BRANDON
Practice Address - State:SUFFOLK
Practice Address - Zip Code:IP27 9PN
Practice Address - Country:GB
Practice Address - Phone:0044163-852-8004
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2719171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider