Provider Demographics
NPI:1316051618
Name:DELIZ, RAFAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:J
Last Name:DELIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAFAEL
Other - Middle Name:J
Other - Last Name:DELIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9114 MCPHERSON RD
Mailing Address - Street 2:SUITE 2509
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6473
Mailing Address - Country:US
Mailing Address - Phone:956-795-1887
Mailing Address - Fax:956-795-1476
Practice Address - Street 1:9114 MCPHERSON RD
Practice Address - Street 2:SUITE 2509
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6473
Practice Address - Country:US
Practice Address - Phone:956-795-1887
Practice Address - Fax:956-795-1476
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2057207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN2057OtherPHYSICIAN LICENSE
TX11136884OtherCAQH
TX11136884OtherCAQH
TX11136884OtherCAQH