Healthcare Provider Details

I. General information

NPI: 1154367464
Provider Name (Legal Business Name): OSVALDO RODRIGUEZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 W NEWBERRY RD SUITE 12
GAINESVILLE FL
32607-2817
US

IV. Provider business mailing address

4881 NW 8TH AVE SUITE 2
GAINESVILLE FL
32605-4582
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-2608
  • Fax: 352-376-0455
Mailing address:
  • Phone: 352-373-6338
  • Fax: 352-373-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME63317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: