Healthcare Provider Details

I. General information

NPI: 1629181326
Provider Name (Legal Business Name): DAGOBERTO JESUS RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: D. J. RODRIGUEZ M.D.

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 N STATE ROAD 7 SUITE 305
MARGATE FL
33063-5737
US

IV. Provider business mailing address

2825 N STATE ROAD 7 SUITE 305
MARGATE FL
33063-5737
US

V. Phone/Fax

Practice location:
  • Phone: 954-752-8799
  • Fax: 954-752-0509
Mailing address:
  • Phone: 954-752-8799
  • Fax: 954-752-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME058463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: