Healthcare Provider Details

I. General information

NPI: 1942293972
Provider Name (Legal Business Name): ALFRED RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 N SUN DR SUITE 3030
LAKE MARY FL
32746-2552
US

IV. Provider business mailing address

807 S ORLANDO AVE SUITE C
WINTER PARK FL
32789-4870
US

V. Phone/Fax

Practice location:
  • Phone: 407-444-2800
  • Fax: 407-444-2810
Mailing address:
  • Phone: 407-894-4693
  • Fax: 407-539-0469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME0061653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: