Healthcare Provider Details

I. General information

NPI: 1407013295
Provider Name (Legal Business Name): WILLIAM FELIX-RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 TAVISTOCK LAKES BLVD SUITE 220
ORLANDO FL
32827-7559
US

IV. Provider business mailing address

9975 TAVISTOCK LAKES BLVD SUITE 220
ORLANDO FL
32827-7559
US

V. Phone/Fax

Practice location:
  • Phone: 407-930-7801
  • Fax: 407-930-7806
Mailing address:
  • Phone: 407-930-7801
  • Fax: 407-930-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberME107554
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME107554
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number04-33108
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: