Healthcare Provider Details

I. General information

NPI: 1649272055
Provider Name (Legal Business Name): JULIO L RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 12/22/2023
Certification Date: 12/05/2023
Deactivation Date: 03/22/2006
Reactivation Date: 06/13/2006

III. Provider practice location address

4881 PALM BEACH BLVD SUITE 100
FORT MYERS FL
33905-3217
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 239-693-9191
  • Fax: 239-693-7369
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0059828
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: