Individual
DR. RAPHAEL ALEXANDER RUSYNYK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
141 MACK BAYOU LOOP STE 101, SANTA ROSA BEACH, FL 32459-7194
(850) 863-5990
(850) 862-0041
Mailing address
417A RACETRACK RD NW STE 2, FORT WALTON BEACH, FL 32547-4604
(850) 863-5990
(850) 862-0041
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
OS8902
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266728200
—
FL
Enumeration date
07/01/2006
Last updated
12/15/2020
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