Dr. Raphael Alexander Rusynyk
Gastroenterologist
141 Mack Bayou Loop Ste 101
Santa Rosa Beach
, Florida 32459-7194
Dr. Raphael Alexander Rusynyk
Gastroenterologist
141 Mack Bayou Loop Ste 101
Santa Rosa Beach
, Florida 32459-7194
(850) 862-0041
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About
Features
Specialties
- Gastroenterologist
Languages spoken
- English
Location
First Address
- Dr. Raphael Alexander Rusynyk
- 417a Racetrack Rd Nw Ste 2
- Fort Walton Beach, FL
- Zip : 32547-4604
- Fax : (850) 862-0041
- Phone : (850) 863-5990
Second Address
- Dr. Raphael Alexander Rusynyk
- 141 Mack Bayou Loop Ste 101
- Santa Rosa Beach, FL
- Zip : 32459-7194
- Fax : (850) 862-0041
- Phone : (850) 863-5990
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RG0100X | Gastroenterologist | OS8902 | FL |
National Provider Identifier
| NPI | 1023047297 |
|---|---|
| Provider Name | Dr. Raphael Alexander Rusynyk |
| First Address | Fort Walton Beach, FL 32547-4604 |
| Second Address | Santa Rosa Beach, FL 32459-7194 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 01/07/2006 |
| Last Update Date | 15/12/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 266728200 | (05) | FL |
| H84831 | (02) | FL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.