Healthcare Provider Details

I. General information

NPI: 1699080341
Provider Name (Legal Business Name): EUGENIO RODRIGUEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 LINTON BLVD SUITE E2
DELRAY BEACH FL
33484-6596
US

IV. Provider business mailing address

PO BOX 9616
CORAL SPRINGS FL
33075-9616
US

V. Phone/Fax

Practice location:
  • Phone: 561-330-4695
  • Fax:
Mailing address:
  • Phone: 954-752-3257
  • Fax: 954-369-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME61779
License Number StateFL

VIII. Authorized Official

Name: DR. EUGENIO RODRIGUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 561-330-4695