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Individual

DR. RAFAEL EUGENIO COPLIN REYNOSO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
900 E BROADWAY AVE, BISMARCK, ND 58501-4520
(701) 530-4777
Mailing address
900 E BROADWAY AVE, BISMARCK, ND 58501-4520
(701) 530-4777

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
45519
KY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
036155263
IL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
25875
WV
207RP1001X
Pulmonary Disease Physician
036155263
IL
208M00000X
Hospitalist Physician
45519
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
051529239
BLUE CROSS BLUE SHIELD
AL
01
110239640
RAILROAD MEDICARE
AL
05
7100213570
KY
Enumeration date
06/02/2006
Last updated
03/30/2022
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