Provider Demographics
NPI:1194734954
Name:PALACIOS, RAFAEL ARMANDO (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:ARMANDO
Last Name:PALACIOS
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:ARMANDO
Other - Last Name:PALACIOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:2412 SE 27TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0703
Mailing Address - Country:US
Mailing Address - Phone:352-867-7116
Mailing Address - Fax:352-867-7116
Practice Address - Street 1:1431 SW 1ST AVE
Practice Address - Street 2:OCALA REGIONAL MEDICAL CENTER, DPMT OF EMERGENCY MED
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-351-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103290363AM0700X
TX04573363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical