Healthcare Provider Details

I. General information

NPI: 1427246776
Provider Name (Legal Business Name): ROBERTO BURGOS-RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S KINGS AVE STE 3000
BRANDON FL
33511-6060
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-6625
  • Fax: 813-684-6043
Mailing address:
  • Phone: 813-286-0033
  • Fax: 787-848-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number17318
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME162762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: