Healthcare Provider Details

I. General information

NPI: 1285840264
Provider Name (Legal Business Name): RODRIGUE TERTUS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10752 EMILIA ISLES TER
BOYNTON BEACH FL
33473-4965
US

IV. Provider business mailing address

10752 EMILIA ISLES TER
BOYNTON BEACH FL
33473-4965
US

V. Phone/Fax

Practice location:
  • Phone: 561-739-8665
  • Fax:
Mailing address:
  • Phone: 973-763-9136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number43ZA00065700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00078700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9107169
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: