Healthcare Provider Details

I. General information

NPI: 1871608885
Provider Name (Legal Business Name): REY L RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 E THOMAS RD
SCOTTSDALE AZ
85251-7216
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: MANAGED CARE DEPT.
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-6896
  • Fax: 480-945-7287
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number43820
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: